1689617953 NPI number — ANESTHESIA SOLUTIONS OF MOBILE, INC.

Table of content: (NPI 1689617953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689617953 NPI number — ANESTHESIA SOLUTIONS OF MOBILE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANESTHESIA SOLUTIONS OF MOBILE, INC.
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:
1689617953
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 610
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21705-0610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-607-8693
Provider Business Mailing Address Fax Number:
240-566-1680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6801 AIRPORT BLVD
Provider Second Line Business Practice Location Address:
ANESTHESIA DEPARTMENT
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36608-3709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-631-3270
Provider Business Practice Location Address Fax Number:
251-631-3273
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHRISTIANSON
Authorized Official First Name:
CLARK
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
251-633-1660

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 529912760 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 362602200 . This is a "US DEPARTMENT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01583765 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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