Eden Anesthesia Services Inc.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

EDEN ANESTHESIA SERVICES INC.

Practice address

31 N Saint Joseph Ave
Niles, MI 49120-2207

Phone

(269) 687-1424

Fax

(269) 687-1472

NPI assigned

Jul 2, 2006

Organization subpart

No

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

Authorized official

Name

Mary Lou Strock

Title

Director

Phone

(269) 983-8195

Specialties & licenses 1

Addresses

Other identifiers 4

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524096000000",
    "number": "1356370241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 N SAINT JOSEPH AVE",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202207",
            "telephone_number": "269-687-1424",
            "fax_number": "269-687-1472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 N SAINT JOSEPH AVE",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202207",
            "telephone_number": "269-687-1424",
            "fax_number": "269-687-1472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDEN ANESTHESIA SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2018-04-19",
        "status": "A",
        "authorized_official_last_name": "STROCK",
        "authorized_official_first_name": "MARY LOU",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "269-983-8195"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-DR",
            "identifier": "050A111210",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-GROUP",
            "identifier": "430A111200",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356370241",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD GROUP",
            "identifier": "CB9923",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gary Otis Duffield Jr., D.C., C.AD.
• Moriah Irene Duncan, LLMSW
• Faith Dykla
• Ashley L Dziubinski, MOTR
• Joshua Michael Eddy, ATC
• Melody A Edwards, LMT
• Thompson U Ejiofor
• Karie Elder
• Sarah Ellenwine, BCBA
• Empowerme Rehabilitation, LLC

• Anesthesiology Physician in Niles, MI
• Providers in Niles, MI by specialty
• Anesthesiology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2018; 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.