Organization Active NPI

Northeast Indiana Anesthesiology, PC

  • Anesthesiology Physician
  • Columbia City, IN
National Provider Identifier
1619917366
Registry record updated Jun 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
NORTHEAST INDIANA ANESTHESIOLOGY, PC
Practice address
353 N Oak St
Columbia City, IN 46725-1623
Phone
(260) 248-9304
NPI assigned
Jun 8, 2006
Last updated
Jun 18, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2008

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

Authorized official

Name
Mrs. Karyn Kovach
Title
Director of Billing
Phone
(419) 531-8808

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X Primary

Addresses

Primary practice location

353 N Oak St
Columbia City, IN 46725-1623

Mailing address

2914 S Republic Blvd
Toledo, OH 43615-1912
Phone (419) 531-8808

Other identifiers 4

IdentifierTypeStateIssuer
200366600BMedicaidIN
200366600AMedicaidIN
200366600CMedicaidIN
CJ6762OtherINRAILROAD MEDICARE

National Provider Directory

National Provider Directory

Locations

2914 S Republic Blvd
Toledo, OH 43615

Practitioners & affiliated clinicians

Practitioners 31

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.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1619917366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2914 S REPUBLIC BLVD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436151912",
            "telephone_number": "419-531-8808",
            "fax_number": "419-531-8877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "353 N OAK ST",
            "city": "COLUMBIA CITY",
            "state": "IN",
            "postal_code": "467251623",
            "telephone_number": "260-248-9304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST INDIANA ANESTHESIOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "KOVACH",
        "authorized_official_first_name": "KARYN",
        "authorized_official_title_or_position": "DIRECTOR OF BILLING",
        "authorized_official_telephone_number": "419-531-8808",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200366600B",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200366600A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200366600C",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CJ6762",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia City, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; 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.