Organization
LEAVENWORTH ANESTHESIA PA
Active
Other names
Mid-America Anesthesia Care
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JEAN M COVILLO CRNA (PRESIDENT)
(913) 680-0812
Entity
Organization
Contact information
Practice address
605 SHAWNEE ST, LEAVENWORTH, KS 66048-1958
(913) 680-0812
(913) 680-1445
Mailing address
605 SHAWNEE ST, LEAVENWORTH, KS 66048-1958
(913) 680-0812
(913) 680-1445
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004640
BCBS
KS
01
—
10811021
BCBS KANSAS CITY
MO
01
—
10811021
PREFERRED HEALTH PROFESSI
—
01
—
C19910
RAILROAD MEDICARE
KS
01
—
CD7473
RAILROAD MEDICARE
MO
01
—
CI9911
RR MEDICARE
KS
01
—
DC6685
RR MEDICARE
MO
Enumeration date
11/18/2005
Last updated
04/20/2008
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