Provider Demographics
NPI:1336751023
Name:CHIPPEWA VALLEY ANESTHESIA ASSOCIATES, S.C.
Entity type:Organization
Organization Name:CHIPPEWA VALLEY ANESTHESIA ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, FACMPE CPA
Authorized Official - Phone:715-834-8721
Mailing Address - Street 1:1101 W CLAIREMONT AVE STE 2C
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6161
Mailing Address - Country:US
Mailing Address - Phone:715-834-8721
Mailing Address - Fax:715-834-3087
Practice Address - Street 1:1000 OAKLEAF WAY
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2246
Practice Address - Country:US
Practice Address - Phone:800-635-6197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-23
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty