Provider Demographics
NPI:1215105143
Name:HEARTLAND ANESTHESIA CONSULTANTS PSC CRNA GROUP
Entity type:Organization
Organization Name:HEARTLAND ANESTHESIA CONSULTANTS PSC CRNA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPALDING
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:270-737-4600
Mailing Address - Street 1:639 NORTH MULBERRY STREET
Mailing Address - Street 2:CRNA GROUP
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701
Mailing Address - Country:US
Mailing Address - Phone:270-737-4600
Mailing Address - Fax:270-737-1722
Practice Address - Street 1:639 NORTH MULBERRY STREET
Practice Address - Street 2:CRNA GROUP
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-737-4600
Practice Address - Fax:270-737-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYCRNA GROUP367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000051346OtherANTHEM
000000051345OtherANTHEM
2434372000OtherPASS ADV
2434376000OtherPASS ADV
KY74900242Medicaid
000000051347OtherANTHEM
1063437OtherPASSPORT GROUP
1063448OtherPASSPORT
2434377000OtherPASS ADV
1063444OtherPASSPORT
1063453OtherPASSPORT
1063454OtherPASSPORT
2434373000OtherPASS ADV
8861OtherANTHEM
000000051352OtherANTHEM
2434370000OtherPASSPORT ADVANTAGE GRP
1063446OtherPASSPORT
2434374000OtherPASS ADV
2434372000OtherPASS ADV
KY8861Medicare UPIN