MEDICARE: ADVANCED ANESTHESIA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	H35058	MD

General Provider Information

NPI Number	:	1194961730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED ANESTHESIA, LLC

Provider Business Mailing Address
First Line	:	8875 CENTRE PARK DR
Second Line	:	SUITE D
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2382
Country	:	US
Telephone Number	:	410-730-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	8875 CENTRE PARK DR
Second Line	:	SUITE D
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2382
Country	:	US
Telephone Number	:	410-730-1000
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. RUSSELL O SCHUB
Credential	:	P.A.
Telephone Number	:	410-730-1000

Provider Enumeration Date	:	01/03/2009
Last Update Date	:	09/24/2009

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