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General NPI Number Information
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NPI Number | 1669615894
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Entity Type | Organization
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Legal Business Name | PROVIDENCE WA ANESTHESIA SERVICES, P.C.
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Dates
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Enumeration Date | 04/17/2009
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 1321 COLBY AVE
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City | EVERETT
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State | WA
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Zip | 98201-1665
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Country | US
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Telephone | 877-580-1908
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Fax | 800-886-1042
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Provider Business Mailing Address
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Address Line | 450 MAMARONECK AVE STE 201
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City | HARRISON
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State | NY
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Zip | 10528-2436
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Country | US
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Telephone | 914-637-2075
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Fax | 914-819-0061
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | DR. MARC E. KOCH
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Credential | M.D.
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Telephone | 877-476-6642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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