Healthcare Provider Details

I. General information

NPI: 1780610139
Provider Name (Legal Business Name): ASSOCIATED ANESTHESIOLOGISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8681 EAGLE POINT BLVD
LAKE ELMO MN
55042-8628
US

IV. Provider business mailing address

8681 EAGLE POINT BLVD
LAKE ELMO MN
55042-8628
US

V. Phone/Fax

Practice location:
  • Phone: 651-251-8021
  • Fax: 651-251-8050
Mailing address:
  • Phone: 651-251-8021
  • Fax: 651-251-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number435
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number435
License Number StateMN

VIII. Authorized Official

Name: DEBBIE LYNN POPHAM
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 651-209-8071