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Organization

GREAT LAKES ANESTHESIA, P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. SETH CLAXTON CRNA (CEO)
(574) 522-9922
Entity
Organization

Contact information

Practice address
700 E BEARDSLEY AVE STE 209, ELKHART, IN 46514-3371
(574) 522-9922
(574) 522-9926
Mailing address
PO BOX 2147, ELKHART, IN 46515-2147
(574) 522-9922
(574) 522-9926

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
367500000X
Certified Registered Nurse Anesthetist
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200250870
IN
Enumeration date
05/12/2006
Last updated
11/06/2024
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