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General NPI Number Information
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NPI Number | 1922603562
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Entity Type | Organization
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Legal Business Name | NETHERLANDS ANESTHESIA, LLC
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Dates
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Enumeration Date | 12/02/2020
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 104 LEGION DR
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City | LAS VEGAS
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State | NM
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Zip | 87701-4804
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Country | US
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Telephone | 505-426-3500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 69342
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City | BALTIMORE
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State | MD
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Zip | 21264-9342
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Country | US
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Telephone | 833-352-0096
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | ALEX GORECKI
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Credential |
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Telephone | 850-497-6702
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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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