MEDICARE: SCL ANESTHESIA PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1205012150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCL ANESTHESIA PLLC

Provider Business Mailing Address
First Line	:	13305 REECK RD
Second Line	:
City	:	SOUTHGATE
State	:	MI
Zip	:	48195-3054
Country	:	US
Telephone Number	:	734-246-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	14050 DIX TOLEDO RD
Second Line	:
City	:	SOUTHGATE
State	:	MI
Zip	:	48195-2501
Country	:	US
Telephone Number	:	734-281-0100
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEVEN C LADSON
Credential	:	CRNA
Telephone Number	:	734-208-7128

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	01/10/2008

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