NPIMap

Organization Active NPI

Excel Anesthesia PSC

  • Certified Registered Nurse Anesthetist
  • Beaver Dam, KY
National Provider Identifier
1104828086
Registry record updated Jul 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
EXCEL ANESTHESIA PSC
Practice address
1020 N Main St
Beaver Dam, KY 42320-1553
Phone
(270) 274-0480
Fax
(270) 274-0482
NPI assigned
Aug 11, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2016

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

Authorized official

Name
Robert L Wright, CRNA
Title
Partner
Phone
(270) 274-0480

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

1020 N Main St
Beaver Dam, KY 42320-1553

Mailing address

1020 N Main St
Beaver Dam, KY 42320-1553
Phone (270) 274-0480

Other identifiers 1

IdentifierTypeStateIssuer
74904137MedicaidKY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469059200000",
    "number": "1104828086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 N MAIN ST",
            "city": "BEAVER DAM",
            "state": "KY",
            "postal_code": "423201553",
            "telephone_number": "270-274-0480",
            "fax_number": "270-274-0482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 N MAIN ST",
            "city": "BEAVER DAM",
            "state": "KY",
            "postal_code": "423201553",
            "telephone_number": "270-274-0480",
            "fax_number": "270-274-0482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEL ANESTHESIA PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-11",
        "last_updated": "2016-07-21",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "270-274-0480",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74904137",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaver Dam, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2016; 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.