1629226873 NPI number — SOUTHFIELD ANESTHESIA, L.L.C.

Table of content: (NPI 1629226873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629226873 NPI number — SOUTHFIELD ANESTHESIA, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHFIELD ANESTHESIA, L.L.C.
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:
1629226873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2690 SOUTHFIELD DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17403-4510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-741-1414
Provider Business Mailing Address Fax Number:
717-741-4774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2690 SOUTHFIELD DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17403-4510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-741-1414
Provider Business Practice Location Address Fax Number:
717-741-4774
Provider Enumeration Date:
08/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
AHLBRANDT
Authorized Official First Name:
DUANE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MD/PRESIDENT
Authorized Official Telephone Number:
717-741-1414

Provider Taxonomy Codes

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

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

  • Identifier: 254646 . This is a "UNISON HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1022119000001 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 139494 . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 002072433 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50081121 . This is a "CAPITAL BLUECROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DO3335 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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