Provider Demographics
NPI:1780616375
Name:GRESS ANESTHESIA SERVICES P.C.
Entity type:Organization
Organization Name:GRESS ANESTHESIA SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:GRESS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:812-482-9617
Mailing Address - Street 1:510 1/2 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3132
Mailing Address - Country:US
Mailing Address - Phone:812-482-9617
Mailing Address - Fax:812-634-7152
Practice Address - Street 1:510 1/2 MAIN ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3132
Practice Address - Country:US
Practice Address - Phone:812-482-9617
Practice Address - Fax:812-634-7152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN55000034A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCC9220Medicare ID - Type Unspecified