Provider Demographics
NPI:1174545214
Name:JOHNSON COUNTY ANESTHESIA
Entity type:Organization
Organization Name:JOHNSON COUNTY ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:VIEHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-736-3576
Mailing Address - Street 1:1801 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-1953
Mailing Address - Country:US
Mailing Address - Phone:765-284-0493
Mailing Address - Fax:765-284-2434
Practice Address - Street 1:1125 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2140
Practice Address - Country:US
Practice Address - Phone:317-736-3576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC9340CMedicare ID - Type UnspecifiedBRENDAN WRYNN, CRNA
CC9340BMedicare ID - Type UnspecifiedLINDA FLEMING, CRNA
E60590Medicare UPIN
CC9340AMedicare ID - Type UnspecifiedCORNELIA HAMMERLY, CRNA
217080AMedicare ID - Type UnspecifiedMARK VIEHMANN, MD
217080BMedicare ID - Type UnspecifiedALAN RINGEL, MD
A62834Medicare UPIN