1477728897 NPI number — LEAR ANESTHESIA SERVICES LLC

Table of content: (NPI 1477728897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477728897 NPI number — LEAR ANESTHESIA SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEAR 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:
1477728897
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7702 LEAR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MC LEAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22102-2734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-288-4669
Provider Business Mailing Address Fax Number:
703-288-4669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2440 M ST NW
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20037-1404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-293-6567
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DESTA
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-288-4669

Provider Taxonomy Codes

  • Taxonomy code: 261QA0006X , with the licence number:  MD30939 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 034597900 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".