Healthcare Provider Details

I. General information

NPI: 1013963644
Provider Name (Legal Business Name): TWIN CITIES ANESTHESIA ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 JACKSON ST
SAINT PAUL MN
55101-2502
US

IV. Provider business mailing address

7 PARKWAY CTR SUITE 375
PITTSBURGH PA
15220-3704
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-3456
  • Fax: 651-254-5560
Mailing address:
  • Phone: 412-937-5700
  • Fax: 412-937-5739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GLENN HALLER
Title or Position: PRESIDENT
Credential: MD
Phone: 651-254-0043