MEDICARE: INSPIRE ANESTHESIA SERVICES 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	367500000X	Certified Registered Nurse Anesthetist	AP30007604	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP30007604	OTHER	WA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1417265760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSPIRE ANESTHESIA SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 97115
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98497-0115
Country	:	US
Telephone Number	:	253-588-7911
Fax Number	:	253-984-6774

Provider Business Practice Location Address
First Line	:	4717 S 19TH ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-1167
Country	:	US
Telephone Number	:	253-588-7911
Fax Number	:	253-984-6774

Authorized Official
Title or Position	:	PROVIDER/OWNER
Name	:	MR. PATRICK LUDWIG KLILMCZYK
Credential	:	CRNA
Telephone Number	:	253-588-7911

Provider Enumeration Date	:	09/21/2010
Last Update Date	:	09/21/2010

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