Organization Active NPI

Anesthesia Intensive Care LLC

  • Critical Care Medicine (Anesthesiology) Physician
  • Davenport, IA
National Provider Identifier
1508387382
Registry record updated Jun 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Anesthesiology) PhysicianTaxonomy code 207LC0200X
Legal business name
ANESTHESIA INTENSIVE CARE LLC
Practice address
1227 E Rusholme St
Davenport, IA 52803-2459
Phone
(563) 421-1000
NPI assigned
Jun 30, 2017
Last updated
Jun 30, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2017

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

Authorized official

Name
Shira Black, D.O.
Title
Owner
Phone
(563) 324-8160

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Anesthesiology) Physician 207LC0200X NU Primary

Addresses

Primary practice location

1227 E Rusholme St
Davenport, IA 52803-2459

Mailing address

PO Box 2490
Davenport, IA 52809-2490

National Provider Directory

National Provider Directory

Locations

1227 E Rusholme St
Davenport, IA 52803
Phone (563) 324-8160

Practitioners & affiliated clinicians

Practitioners 1

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": "1498780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498780800000",
    "number": "1508387382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2490",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528092490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1227 E RUSHOLME ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528032459",
            "telephone_number": "563-421-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANESTHESIA INTENSIVE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-30",
        "last_updated": "2017-06-30",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "SHIRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "563-324-8160",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2017; 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.