Provider Demographics
NPI:1174513246
Name:ONE ANESTHESIA PLLC
Entity type:Organization
Organization Name:ONE ANESTHESIA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-473-2132
Mailing Address - Street 1:PO BOX 70354
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40270-0354
Mailing Address - Country:US
Mailing Address - Phone:502-473-2132
Mailing Address - Fax:502-459-0923
Practice Address - Street 1:100 MALLARD CREEK RD
Practice Address - Street 2:SUITE 320
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4194
Practice Address - Country:US
Practice Address - Phone:502-473-2132
Practice Address - Fax:502-459-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65911513Medicaid
KY74900598Medicaid
KY65911513Medicaid
KY2766Medicare PIN