Provider Demographics
NPI:1356414197
Name:RELIABLE ANESTHEZIA AND PAIN MANAGEMENT SERVICES PSC
Entity type:Organization
Organization Name:RELIABLE ANESTHEZIA AND PAIN MANAGEMENT SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-258-2873
Mailing Address - Street 1:PO BOX 501063
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-6063
Mailing Address - Country:US
Mailing Address - Phone:317-258-2873
Mailing Address - Fax:866-588-8131
Practice Address - Street 1:2209 JOHN R WOODEN DR
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1840
Practice Address - Country:US
Practice Address - Phone:765-342-8441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062928A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1073566097OtherCMUNDELIUS NPI#
IN1205984366OtherSKRISTIANSEN NPI#
IN1598825762OtherMARANT NPI#
IN1780602094OtherTRENT MILLER MD NPI#
IN1285743310OtherROESTERLING NPI#
IN1912992124OtherDWHITAKER NPI#
IN1285743310OtherROESTERLING NPI#