Provider Demographics
NPI:1285148643
Name:RIVER VALLEY ANESTHESIA, INC.
Entity type:Organization
Organization Name:RIVER VALLEY ANESTHESIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-246-3018
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-0118
Mailing Address - Country:US
Mailing Address - Phone:715-246-3018
Mailing Address - Fax:715-246-3019
Practice Address - Street 1:130 S. KNOWLES AVE.
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017
Practice Address - Country:US
Practice Address - Phone:715-246-3018
Practice Address - Fax:715-246-3019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty