Provider Demographics
NPI:1104968957
Name:NEW BROOKE ANESTHESIOLOGISTS PC
Entity type:Organization
Organization Name:NEW BROOKE ANESTHESIOLOGISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIEVES
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-945-2047
Mailing Address - Street 1:3018 BROOKHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9439
Mailing Address - Country:US
Mailing Address - Phone:812-945-2047
Mailing Address - Fax:812-945-2047
Practice Address - Street 1:3018 BROOKHAVEN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9439
Practice Address - Country:US
Practice Address - Phone:812-945-2047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100405570AMedicaid
INNE244100Medicare ID - Type Unspecified