Healthcare Provider Details

I. General information

NPI: 1518667062
Provider Name (Legal Business Name): SLOTHWORKS ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 06/08/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 1/2 ROSEMONT AVE
LOS ANGELES CA
90026-5299
US

IV. Provider business mailing address

117 1/2 ROSEMONT AVE
LOS ANGELES CA
90026-5299
US

V. Phone/Fax

Practice location:
  • Phone: 763-772-3010
  • Fax:
Mailing address:
  • Phone: 763-772-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ADAM CHRISTOPHER SCHENK
Title or Position: OWNER
Credential:
Phone: 763-772-3010