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General NPI Number Information
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NPI Number | 1881875920
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Entity Type | Organization
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Legal Business Name | MEMORIAL ANESTHESIA, LLC
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 09/17/2008
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Provider Practice Location Address
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Address Line | 8262 ATLEE RD. MOB 3 #100
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City | MECHANICSVILLE
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State | VA
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Zip | 23116
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Country | US
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Telephone | 804-746-6969
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Fax | 804-746-6950
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Provider Business Mailing Address
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Address Line | PO BOX 778
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City | MT. AIRY
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State | MD
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Zip | 21771
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Country | US
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Telephone | 301-829-7683
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Fax | 301-829-7694
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | REN J LEWIS
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Credential |
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Telephone | 301-829-7683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State | VA
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Taxonomy #2
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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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