=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043680101
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OFFICE ANESTHESIA, PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2015
-----------------------------------------------------
Last Update Date | 10/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4580 STATE ST #144
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48603-3803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-798-1045
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4580 STATE ST #144
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48603-3803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-798-1045
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | DR. THOMAS M MINNEC
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 989-798-1045
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------