=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235033523
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGELESS FACILITY ANESTHESIA PARTNERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2026
-----------------------------------------------------
Last Update Date | 10/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1133 21ST ST NW STE 200
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20036-3324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-202-7479
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5361 GREENWICH CIR
-----------------------------------------------------
City | UPPER MARLBORO
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20772-4862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-202-7479
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALEXIS BENNETT
-----------------------------------------------------
Credential | CRNA
-----------------------------------------------------
Telephone | 504-202-7479
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------