Provider Demographics
NPI:1215608096
Name:ELITE ANESTHESIA LLC
Entity type:Organization
Organization Name:ELITE ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:DURBIN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:270-559-0765
Mailing Address - Street 1:2780 - D NEW HOLT RD
Mailing Address - Street 2:BOX 239
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001
Mailing Address - Country:US
Mailing Address - Phone:270-276-6502
Mailing Address - Fax:270-276-6503
Practice Address - Street 1:4645 VILLAGE SQUARE DR STE C
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7448
Practice Address - Country:US
Practice Address - Phone:270-276-6502
Practice Address - Fax:270-276-6503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty