Healthcare Provider Details

I. General information

NPI: 1407402365
Provider Name (Legal Business Name): CAPITAL ANESTHESIA SOLUTIONS OF PHILADELPHIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 RIDGE AVENUE
PHILADELPHIA PA
19128
US

IV. Provider business mailing address

PO BOX 72309
CLEVELAND OH
44192-0002
US

V. Phone/Fax

Practice location:
  • Phone: 855-495-1400
  • Fax:
Mailing address:
  • Phone: 239-610-0775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MELISSA HARLAN
Title or Position: DIRECTOR
Credential:
Phone: 615-577-6340