1376654434 NPI number — OUTPATIENT ANESTHESIA SERVICES OF RESTON, LTD

Table of content: (NPI 1376654434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376654434 NPI number — OUTPATIENT ANESTHESIA SERVICES OF RESTON, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUTPATIENT ANESTHESIA SERVICES OF RESTON, LTD
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:
1376654434
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2699
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RESTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20195-0699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-471-0919
Provider Business Mailing Address Fax Number:
703-742-9081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1860 TOWN CENTER DR # 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RESTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20190-5896
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-471-0919
Provider Business Practice Location Address Fax Number:
703-742-9081
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPARKS-JENET
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-471-0919

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  0632910 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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