MEDICARE: SECURUS 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	207L00000X	Anesthesiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	612371800	OTHER	MD	US DEPT OF LABOR

General Provider Information

NPI Number	:	1750594347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECURUS ANESTHESIA LLC

Provider Business Mailing Address
First Line	:	PO BOX 7096
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95267-0096
Country	:	US
Telephone Number	:	209-956-7725
Fax Number	:	209-956-7733

Provider Business Practice Location Address
First Line	:	1111 BEARDS HILL RD
Second Line	:	SUITE 700
City	:	ABERDEEN
State	:	MD
Zip	:	21001-2232
Country	:	US
Telephone Number	:	410-273-9096
Fax Number	:

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	DAVID CHARLES SANTAMORE
Credential	:	MD
Telephone Number	:	410-273-9096

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	06/29/2015

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Directions to “SECURUS ANESTHESIA LLC ” Practice Location

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