1316026149 NPI number — GENESEE VALLEY ANESTHESIOLOGISTS

Table of content: (NPI 1316026149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316026149 NPI number — GENESEE VALLEY ANESTHESIOLOGISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESEE VALLEY ANESTHESIOLOGISTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316026149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
141 VERSTREET DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14616-4105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-730-8240
Provider Business Mailing Address Fax Number:
585-730-8311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
980 WESTFALL RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14618-2605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-730-8240
Provider Business Practice Location Address Fax Number:
585-730-8311
Provider Enumeration Date:
11/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAWSON
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
585-370-8240

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1316026149 . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6532 . This is a "ROCH BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0187640590 . This is a "BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01610640 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".