1821323254 NPI number — ADVANCED ANESTHESIOLOGY SERVICES, LLC

Table of content: (NPI 1821323254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821323254 NPI number — ADVANCED ANESTHESIOLOGY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED ANESTHESIOLOGY 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:
1821323254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 MOUNT WOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26003-2632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-233-2455
Provider Business Mailing Address Fax Number:
304-233-6073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 TRICH DRIVE
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301-5892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-582-4411
Provider Business Practice Location Address Fax Number:
724-582-4343
Provider Enumeration Date:
10/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ROIG
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
304-233-2455

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  MD073048L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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