Provider Demographics
NPI:1316918816
Name:AD ASTRA ANESTHESIA, LLC
Entity type:Organization
Organization Name:AD ASTRA ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:316-788-5939
Mailing Address - Street 1:727 N BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-1609
Mailing Address - Country:US
Mailing Address - Phone:316-788-5939
Mailing Address - Fax:316-788-5945
Practice Address - Street 1:727 N BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-1609
Practice Address - Country:US
Practice Address - Phone:316-788-5939
Practice Address - Fax:316-788-5945
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIAL ANESTHESIA SERVICES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-01
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty