NPIMap

Organization Active NPI

Innovus Anesthesia LLC

  • Certified Registered Nurse Anesthetist
  • Portland, OR
National Provider Identifier
1619558350
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
INNOVUS ANESTHESIA LLC
Practice address
9701 SW Barnes Rd Ste 300
Portland, OR 97225-6689
Phone
(843) 651-2624
Fax
(843) 491-4023
NPI assigned
Apr 15, 2021
Last updated
Apr 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2021

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

Authorized official

Name
Michael T Mitchell
Title
Managing MBR
Phone
(843) 651-2624

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU
Certified Registered Nurse Anesthetist 367500000X NU Primary

Addresses

Primary practice location

9701 SW Barnes Rd Ste 300
Portland, OR 97225-6689

Mailing address

PO Box 4860
Murrells Inlet, SC 29576-2698
Phone (843) 651-2624

National Provider Directory

National Provider Directory

Locations

1508 Division St
Ste 205
Oregon City, OR 97045
Phone (503) 657-1071

1111 NE 99th Ave
Ste 32
Portland, OR 97220
Phone (503) 963-2707

700 NE Multnomah St
Ste 1650
Portland, OR 97232
Phone (503) 734-1850

9701 SW Barnes Rd
Ste 150
Portland, OR 97225
Phone (503) 734-3535

9701 SW Barnes Rd
Ste 300
Portland, OR 97225
Phone (503) 297-8081

19250 SW 65th Ave
Ste 325
Tualatin, OR 97062
Phone (503) 692-1242

Practitioners & affiliated clinicians

Practitioners 4

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": "1618444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618444800000",
    "number": "1619558350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4860",
            "city": "MURRELLS INLET",
            "state": "SC",
            "postal_code": "295762698",
            "telephone_number": "843-651-2624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9701 SW BARNES RD STE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256689",
            "telephone_number": "843-651-2624",
            "fax_number": "843-491-4023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVUS ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-15",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "MANAGING MBR",
        "authorized_official_telephone_number": "843-651-2624"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2021; 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.