Healthcare Provider Details

I. General information

NPI: 1932482098
Provider Name (Legal Business Name): ESSENTIAL ANESTHESIA SERVICES, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 W MAPLE RD SUITE 200
TROY MI
48084-5458
US

IV. Provider business mailing address

PO BOX 4860
MURRELLS INLET SC
29576-2698
US

V. Phone/Fax

Practice location:
  • Phone: 248-244-9578
  • Fax:
Mailing address:
  • Phone: 843-651-2624
  • Fax: 843-357-4940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD62587
License Number StateMI

VIII. Authorized Official

Name: CHAR EVERETT STOOPS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 248-244-9578