Healthcare Provider Details

I. General information

NPI: 1063487056
Provider Name (Legal Business Name): ANESTHESIA SERVICE INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 E KINCAID ST
MOUNT VERNON WA
98274-4126
US

IV. Provider business mailing address

PO BOX 2329
MOUNT VERNON WA
98273-7329
US

V. Phone/Fax

Practice location:
  • Phone: 360-336-6517
  • Fax: 360-466-2682
Mailing address:
  • Phone: 360-336-6517
  • Fax: 360-466-2682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateWA

VIII. Authorized Official

Name: CHAR L MELDAHL
Title or Position: GROUP ADMINISTRATOR
Credential:
Phone: 360-466-2542