Provider Demographics
NPI:1194775239
Name:OBSTETRIC ANESTHESIA CONSULTANTS PSC
Entity type:Organization
Organization Name:OBSTETRIC ANESTHESIA CONSULTANTS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF GROUP
Authorized Official - Prefix:
Authorized Official - First Name:MUSHTAQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNEJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-629-2880
Mailing Address - Street 1:3217 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0001
Mailing Address - Country:US
Mailing Address - Phone:706-650-0705
Mailing Address - Fax:
Practice Address - Street 1:200 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-629-2880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100021480Medicaid
KY74900432Medicaid
KY65917841Medicaid
KY65917841Medicaid