=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356613087
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PENINSULA ANESTHESIA CONSULTANTS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2012
-----------------------------------------------------
Last Update Date | 01/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 SULLIVAN AVE
-----------------------------------------------------
City | DALY CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94015-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-302-0101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 804 SCOTT NIXON MEMORIAL DR
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30907-2464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-650-0705
-----------------------------------------------------
Fax | 706-650-1034
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CATHERINE HAMILTON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 650-302-0101
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------