=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922255488
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESTSIDE ANESTHESIOLOGY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2008
-----------------------------------------------------
Last Update Date | 08/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 AMSTERDAM AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10025-1716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-523-2309
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 804 SCOTT NIXON MEMORIAL DR
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30907-2464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-394-4445
-----------------------------------------------------
Fax | 706-650-1034
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ANESTHESIOLOGIST
-----------------------------------------------------
Name | ALAN C SANTOS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 212-523-2309
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------