Healthcare Provider Details

I. General information

NPI: 1356956023
Provider Name (Legal Business Name): PENNSYLVANIA MOBILE ANESTHESIA ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 S MAIN ST
SLIPPERY ROCK PA
16057-1247
US

IV. Provider business mailing address

234 S MAIN ST
SLIPPERY ROCK PA
16057-1247
US

V. Phone/Fax

Practice location:
  • Phone: 724-794-2224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY BORANDI
Title or Position: ANESTHESIOLOGIST-OWNER
Credential:
Phone: 412-725-1184