Provider Demographics
NPI:1548442650
Name:LOUISVILLE ANESTHESIA PROVISION LLC
Entity type:Organization
Organization Name:LOUISVILLE ANESTHESIA PROVISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:843-651-2624
Mailing Address - Street 1:PO BOX 2429
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-2429
Mailing Address - Country:US
Mailing Address - Phone:502-693-5421
Mailing Address - Fax:
Practice Address - Street 1:1400 POPLAR LEVEL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1309
Practice Address - Country:US
Practice Address - Phone:502-637-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty