1902950603 NPI number — FIRST STATE ANESTHESIA SERVICES LLC

Table of content: (NPI 1902950603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902950603 NPI number — FIRST STATE ANESTHESIA SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST STATE 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:
1902950603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6385
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19804-0985
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-225-2380
Provider Business Mailing Address Fax Number:
302-225-2388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4923 OGLETOWN STANTON RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19713-2081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-225-2380
Provider Business Practice Location Address Fax Number:
302-225-2388
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KANCHANA
Authorized Official First Name:
THIRUMALESHAWAR
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN COORDINATOR
Authorized Official Telephone Number:
302-225-2380

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: 7567859 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2818802000 . This is a "AMERIHEALTH/KEYSTONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: DG28116 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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