Healthcare Provider Details

I. General information

NPI: 1467782748
Provider Name (Legal Business Name): RACINE ANESTHESIA SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 SPRING ST
MOUNT PLEASANT WI
53405-1667
US

IV. Provider business mailing address

265 BROOKVIEW CENTRE WAY STE 203
KNOXVILLE TN
37919-4053
US

V. Phone/Fax

Practice location:
  • Phone: 262-687-4011
  • Fax:
Mailing address:
  • Phone: 865-985-7114
  • Fax: 865-692-5867

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: STACEY WILSON
Title or Position: DIRECTOR
Credential:
Phone: 865-985-7114