Healthcare Provider Details

I. General information

NPI: 1073731436
Provider Name (Legal Business Name): SURGICAL ANESTHESIA OF GETTYSBURG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 FAME AVENUE SUITE 130
HANOVER PA
17331-1576
US

IV. Provider business mailing address

PO BOX #8500 LOCKBOX #2652
PHILADELPHIA PA
19178-2652
US

V. Phone/Fax

Practice location:
  • Phone: 866-259-1462
  • Fax: 706-650-1034
Mailing address:
  • Phone: 866-259-1462
  • Fax: 706-650-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ANDREW R. RIBAUDO
Title or Position: PRESIDENT
Credential:
Phone: 404-446-1417