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General NPI Number Information
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NPI Number | 1922377191
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL ANESTHESIA SERVICES PA
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Dates
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Enumeration Date | 12/18/2011
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 375 S WICKHAM RD
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City | MELBOURNE
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State | FL
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Zip | 32904-1135
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Country | US
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Telephone | 321-726-9393
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Fax | 321-726-9395
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Provider Business Mailing Address
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Address Line | 249 LANSING ISLAND DR
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-5102
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Country | US
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Telephone | 321-242-9599
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Fax | 321-242-9599
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER THESSEN
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Credential |
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Telephone | 321-242-9599
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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 | ME81504
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License Number State | FL
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