Healthcare Provider Details

I. General information

NPI: 1003320151
Provider Name (Legal Business Name): ENVISION ANESTHESIA SERVICES OF DELAWARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 08/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18791 JOHN J WILLIAMS HWY
REHOBOTH BEACH DE
19971-4401
US

IV. Provider business mailing address

PO BOX 744471
ATLANTA GA
30374-4471
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax: 913-242-6850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN KONDAS
Title or Position: OFFICER
Credential:
Phone: 954-838-2371