Healthcare Provider Details

I. General information

NPI: 1720192230
Provider Name (Legal Business Name): AMBULATORY ANESTHESIA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 WALKER LANE #200
ALEXANDRIA VA
22310
US

IV. Provider business mailing address

PO BOX 612926
DALLAS TX
75261-2926
US

V. Phone/Fax

Practice location:
  • Phone: 703-922-9501
  • Fax: 703-922-5347
Mailing address:
  • Phone: 239-610-0775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRIAN P WOODS
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 214-687-0015