Provider Demographics
NPI:1104089275
Name:KNOXVILLE AREA ANESTHESIA SERVICES
Entity type:Organization
Organization Name:KNOXVILLE AREA ANESTHESIA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ECK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:641-664-3602
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52537-0054
Mailing Address - Country:US
Mailing Address - Phone:641-664-3602
Mailing Address - Fax:614-664-3765
Practice Address - Street 1:1002 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-3121
Practice Address - Country:US
Practice Address - Phone:641-842-2151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD065366367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA26571Medicare PIN