Provider Demographics
NPI:1871568493
Name:NORTHWEST IOWA ANESTHESIA ASSOCIATES
Entity type:Organization
Organization Name:NORTHWEST IOWA ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:H
Authorized Official - Last Name:KROLL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:712-240-2169
Mailing Address - Street 1:400 10TH ST E
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4552
Mailing Address - Country:US
Mailing Address - Phone:888-209-0305
Mailing Address - Fax:952-442-3620
Practice Address - Street 1:1200 1ST AVE E
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4342
Practice Address - Country:US
Practice Address - Phone:888-209-0305
Practice Address - Fax:952-442-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0265561Medicaid
105789OtherCARE CHOICES COMMERCIAL
MN51922NOOtherBLUE CROSS OF MN - NONPAR
MN377878900Medicaid
IA26556OtherBLUE CROSS OF IOWA
IA26556OtherBLUE CROSS OF IOWA
NE=========13Medicaid
MN377878900Medicaid