Healthcare Provider Details

I. General information

NPI: 1245284371
Provider Name (Legal Business Name): PARK ANESTHESIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 PARK ST ANESTHESIA DEPARTMENT
ATTLEBORO MA
02703-3143
US

IV. Provider business mailing address

PO BOX 845706
BOSTON MA
02284-5706
US

V. Phone/Fax

Practice location:
  • Phone: 508-236-7430
  • Fax: 508-236-7446
Mailing address:
  • Phone: 800-720-1664
  • Fax: 207-753-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK LEBOVITS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 508-236-7430