NPIMap

Organization Active NPI

Traverse Anesthesia Associates, PC

  • Pain Medicine (Anesthesiology) Physician
  • Traverse City, MI
National Provider Identifier
1013966506
Registry record updated Nov 2, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
TRAVERSE ANESTHESIA ASSOCIATES, PC
Practice address
1105 6TH St
Munson Medical Center/Traverse Anesthesia Associates, P
Traverse City, MI 49684-2349
Phone
(231) 935-5770
Fax
(231) 935-0747
NPI assigned
May 10, 2006
Last updated
Nov 2, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Nikki Killian
Title
Business Office Coordinator
Phone
(231) 935-5770

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Certified Registered Nurse Anesthetist 367500000X NU
Pain Medicine (Anesthesiology) Physician 207LP2900X NU Primary

Addresses

Primary practice location

1105 6TH St
Munson Medical Center/Traverse Anesthesia Associates, P
Traverse City, MI 49684-2349

Mailing address

4100 Park Forest Dr
Suite 210
Traverse City, MI 49684-7331
Phone (231) 935-5770

National Provider Directory

National Provider Directory

Locations

2505 Momentum Pl
Chicago, IL 60689

224 Park Ave
Frankfort, MI 49635
Phone (231) 352-2200

1105 Sixth St
#P
Traverse City, MI 49684
Phone (231) 935-5770

4100 Park Forest Dr
Ste 21
Traverse City, MI 49684

4100 Park Forest Dr
Ste 210
Traverse City, MI 49684
Phone (231) 935-5770

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193961600000",
    "number": "1013966506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 PARK FOREST DR",
            "address_2": "SUITE 210",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847331",
            "telephone_number": "231-935-5770",
            "fax_number": "231-935-0747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 6TH ST",
            "address_2": "MUNSON MEDICAL CENTER/TRAVERSE ANESTHESIA ASSOCIATES, P",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842349",
            "telephone_number": "231-935-5770",
            "fax_number": "231-935-0747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRAVERSE ANESTHESIA ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2007-11-02",
        "status": "A",
        "authorized_official_last_name": "KILLIAN",
        "authorized_official_first_name": "NIKKI",
        "authorized_official_title_or_position": "BUSINESS OFFICE COORDINATOR",
        "authorized_official_telephone_number": "231-935-5770",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.