| Midwest Ketafusion Llc | |
|
1700 S 1st Ave Ste 25a Iowa City IA 52240-6036 | |
| (319) 849-8114 | |
| (319) 333-0624 |
| Full Name | Midwest Ketafusion Llc |
|---|---|
| Speciality | Anesthesiology |
| Location | 1700 S 1st Ave Ste 25a, Iowa City, Iowa |
| Authorized Official Name and Position | Charlie Hong (NURSE ANESTHETIST) |
| Authorized Official Contact | 3193314391 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midwest Ketafusion Llc 1700 S 1st Ave Ste 25a Iowa City IA 52240-6036 Ph: (319) 849-8114 | Midwest Ketafusion Llc 1700 S 1st Ave Ste 25a Iowa City IA 52240-6036 Ph: (319) 849-8114 |
| NPI Number | 1831790104 |
|---|---|
| Provider Enumeration Date | 11/04/2020 |
| Last Update Date | 04/25/2023 |
| Certification Date | 04/25/2023 |
| Medicare PECOS PAC ID | 4284091323 |
|---|---|
| Medicare Enrollment ID | O20230606001724 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831790104 | NPI | - | NPPES |
| Provider Name | Charlie Chia Hsun Hong |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1558662478 PECOS PAC ID: 5890975940 Enrollment ID: I20150311001974 |
| Provider Name | Ross Van Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023727567 PECOS PAC ID: 0840657763 Enrollment ID: I20230608002140 |
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