Healthcare Provider Details

I. General information

NPI: 1699075135
Provider Name (Legal Business Name): MOBILE ANESTHESIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 HOSPITAL RD
COAL TOWNSHIP PA
17866-9668
US

IV. Provider business mailing address

PO BOX 237
RINGTOWN PA
17967-0237
US

V. Phone/Fax

Practice location:
  • Phone: 570-644-6109
  • Fax: 570-644-4363
Mailing address:
  • Phone: 570-889-5378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD418250
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD418250
License Number StatePA

VIII. Authorized Official

Name: DR. PATRICK T KONITZER
Title or Position: OWNER
Credential: M.D.
Phone: 570-889-5378