1548443153 NPI number — MANASSAS SURGERY CENTER ANESTHESIA SERVICES, LLC

Table of content: (NPI 1548443153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548443153 NPI number — MANASSAS SURGERY CENTER ANESTHESIA SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANASSAS SURGERY CENTER ANESTHESIA SERVICES, LLC
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:
1548443153
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 COMMERCE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ROCHELLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10801-5214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-637-3510
Provider Business Mailing Address Fax Number:
914-819-0061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8409 DORSEY CIR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MANASSAS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20110-8305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-580-0181
Provider Business Practice Location Address Fax Number:
703-897-8763
Provider Enumeration Date:
12/06/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KOCH
Authorized Official First Name:
MARC
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
914-637-3511

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: 1548443153 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".