Healthcare Provider Details

I. General information

NPI: 1659458149
Provider Name (Legal Business Name): OUTPATIENT ANESTHESIA SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 PACIFIC AVE SUITE 100
EVERETT WA
98201-4261
US

IV. Provider business mailing address

PO BOX 5908
BELLEVUE WA
98006-0408
US

V. Phone/Fax

Practice location:
  • Phone: 425-339-2433
  • Fax:
Mailing address:
  • Phone: 206-244-1212
  • Fax: 206-244-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL P FLACCO
Title or Position: PROVIDER DESIGNEE
Credential: M.D.
Phone: 206-244-1212