Evanston Anesthesia Associates, LLC
Organization Active NPI Certified Registered Nurse Anesthetist · Evanston, WY
NPI 1891979258 · NPPES record last updated Dec 20, 2007
Key facts
- NPI
- 1891979258
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- Legal business name
- EVANSTON ANESTHESIA ASSOCIATES, LLC
- Practice address
- 190 Arrowhead Dr
Evanston, WY 82930-9266 - Phone
- (307) 783-8289
- Fax
- (307) 789-3760
- NPI assigned
- Dec 20, 2007
- Organization subpart
- No
Authorized official
- Name
- Richard Carver, CRNA
- Title
- Business Manager
- Phone
- (307) 789-1219
Practitioners 5
-
Richard Carver, CRNA
-
Michael Hunt, CRNA, FNP, APRN
-
Scott S Felt, CRNA
-
Justin R Fenus, JUSTIN FENUS
-
Mark E Wilson, CRNA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080423000335 | WY | Part B Supplier - Clinic/Group Practice | 5991883514 |
Receives reassigned benefits from 5 practitioners Practice locations: Evanston, WY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist |
367500000X | Yes |
Addresses
Primary practice location
190 Arrowhead Dr
Evanston, WY 82930-9266
Mailing address
PO Box 1477
Evanston, WY 82931-1477
Phone (307) 789-1219
NPI Registry JSON
{
"created_epoch": "1198108800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1198108800000",
"number": "1891979258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1477",
"city": "EVANSTON",
"state": "WY",
"postal_code": "829311477",
"telephone_number": "307-789-1219",
"fax_number": "307-789-3760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "190 ARROWHEAD DR",
"city": "EVANSTON",
"state": "WY",
"postal_code": "829309266",
"telephone_number": "307-783-8289",
"fax_number": "307-789-3760"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EVANSTON ANESTHESIA ASSOCIATES, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-12-20",
"last_updated": "2007-12-20",
"status": "A",
"authorized_official_last_name": "CARVER",
"authorized_official_first_name": "RICHARD",
"authorized_official_title_or_position": "BUSINESS MANAGER",
"authorized_official_telephone_number": "307-789-1219",
"authorized_official_credential": "CRNA"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Anesthetist, Certified Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evanston, WY
- Ella Hauck Erickson
- Tiffany Eskelson-Maestas
- Georgeanna Espinioza
- Danalynn M Esponge-Brisbois
- Sherri Eurich
- Evanston Child Development Center
- Evanston Chiropractic Center Inc.
- Evanston Clinic Corp
- Evanston Collaborative Health LLC
- Evanston Dental,LLC
All providers in Evanston, WY · Certified Registered Nurse Anesthetist in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.