MEDICARE: PRECISE ANESTHETIC,LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center	R137569	MD

General Provider Information

NPI Number	:	1588196349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECISE ANESTHETIC,LLC

Provider Business Mailing Address
First Line	:	2060 PHILLIPS MILL RD
Second Line	:
City	:	FOREST HILL
State	:	MD
Zip	:	21050-2119
Country	:	US
Telephone Number	:	410-652-4598
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 BOX HILL CORPORATE CENTER DR
Second Line	:
City	:	ABINGDON
State	:	MD
Zip	:	21009-1200
Country	:	US
Telephone Number	:	410-652-4598
Fax Number	:

Authorized Official
Title or Position	:	CRNA
Name	:	HAMID R KHAIRGHADAM
Credential	:	NURSE ANESTHETIST
Telephone Number	:	410-652-4598

Provider Enumeration Date	:	03/31/2017
Last Update Date	:	03/31/2017

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