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General NPI Number Information
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NPI Number | 1063487056
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Entity Type | Organization
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Legal Business Name | ANESTHESIA SERVICE INC PS
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1415 E KINCAID ST
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City | MOUNT VERNON
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State | WA
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Zip | 98274-4126
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Country | US
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Telephone | 360-336-6517
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Fax | 360-466-2682
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Provider Business Mailing Address
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Address Line | PO BOX 2329
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City | MOUNT VERNON
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State | WA
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Zip | 98273-7329
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Country | US
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Telephone | 360-336-6517
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Fax | 360-466-2682
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Authorized Official
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Title or Position | GROUP ADMINISTRATOR
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Name | CHAR L MELDAHL
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Credential |
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Telephone | 360-466-2542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number |
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License Number State | WA
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