MEDICARE: STANTON ANESTHESIA INC

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	207L00000X	Anesthesiology Physician	21904	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DB1576	OTHER	OK	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	348047100	OTHER	OK	DOL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	5860324	OTHER	OK	AETNA

General Provider Information

NPI Number	:	1336135425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANTON ANESTHESIA INC

Provider Business Mailing Address
First Line	:	PO BOX 25016
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73125
Country	:	US
Telephone Number	:	405-775-9350
Fax Number	:	405-775-9360

Provider Business Practice Location Address
First Line	:	3705 W MEMORIAL RD
Second Line	:	SUITE 302
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1512
Country	:	US
Telephone Number	:	405-775-9350
Fax Number	:	405-775-9360

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	CATHY PRICE
Credential	:
Telephone Number	:	405-775-9350

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	06/05/2008

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Directions to “STANTON ANESTHESIA INC ” Practice Location

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