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  7. NPI Record 1184972663

DREW ANESTHESIA
Complete NPI Record 1184972663
Nurse Anesthetist, Certified Registered in Monticello, AR

NPI Status: Active since August 15, 2012

Contact Information

778 SCOGIN DR
MONTICELLO, AR
ZIP 71655
Phone: (870) 367-2411
Fax: (952) 442-3620

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider Business Mailing Address Fax Number
  14. Provider First Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Authorized Official Last Name
  24. Authorized Official First Name
  25. Authorized Official Title or Position
  26. Authorized Official Telephone Number
  27. Healthcare Provider Taxonomy Code 1
  28. Healthcare Provider Primary Taxonomy Switch 1
  29. Is Organization Subpart
  30. Parent Organization LBN
  31. Parent Organization TIN
  32. Healthcare Provider Taxonomy Group 1

Complete NPI Dataset

This page represents the complete record for NPI 1184972663. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1184972663
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The last name of the provider. If the provider is an individual, this is the legal name.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: DREW ANESTHESIA
The middle name of the provider, if the provider is an individual.
Provider Other Organization Name Type Code: 3
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Provider First Line Business Mailing Address: 400 E 10TH ST
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider Business Mailing Address City Name: WACONIA
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address State Name: MN
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address Postal Code: 553874552
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Country Code If outside U S : US
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Telephone Number: 9524429770
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Fax Number: 9524423620
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 778 SCOGIN DR
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: MONTICELLO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: AR
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 716555729
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 8703672411
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 9524423620
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 8/15/2012
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 10/12/2012
The date that a record was last updated or changed.
Authorized Official Last Name: CLARK
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: SHANNON
The first name of the authorized official.
Authorized Official Title or Position: CFO
Authorized Official Telephone Number: 8703672411
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Healthcare Provider Taxonomy Code 1: 367500000X
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Healthcare Provider Primary Taxonomy Switch 1: Y
The last name of the provider. If the provider is an individual, this is the legal name.
Is Organization Subpart: Y
The first name of the provider, if the provider is an individual.
Parent Organization LBN: DREW MEMORIAL HOSPITAL, INC.
The middle name of the provider, if the provider is an individual.
Parent Organization TIN: UNAVAIL
Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP