Healthcare Provider Details

I. General information

NPI: 1831598457
Provider Name (Legal Business Name): PANACEA ANESTHESIA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 AIRPORT RD
MEDFORD OR
97504-4159
US

IV. Provider business mailing address

PO BOX 4069
EVERETT WA
98204-0007
US

V. Phone/Fax

Practice location:
  • Phone: 541-608-2590
  • Fax:
Mailing address:
  • Phone: 425-407-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEVEN SCOTT CROWTHERS
Title or Position: CRNA
Credential: CRNA
Phone: 970-946-2918