Organization
MARSHALL COUNTY ANESTHESIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA JOHNSON (BILLING AGENCY)
(270) 382-3112
Entity
Organization
Contact information
Practice address
615 OLD SYMSONIA RD, BENTON, KY 42025-5042
(270) 527-4800
Mailing address
PO BOX 15, LYNNVILLE, KY 42063-0015
(270) 382-3112
(270) 382-3112
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
034465
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000060201
BLUE SHIELD PIN
KY
Enumeration date
07/08/2009
Last updated
02/22/2011
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