MEDICARE: ANESTHESIA MANAGEMENT SERVICES, 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	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1679525661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANESTHESIA MANAGEMENT SERVICES, LLC

Provider Business Mailing Address
First Line	:	11999 SAN VICENTE BLVD
Second Line	:	#440
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5131
Country	:	US
Telephone Number	:	310-471-5852
Fax Number	:	310-472-9582

Provider Business Practice Location Address
First Line	:	2522 WARM SPRINGS RD
Second Line	:	#B
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5640
Country	:	US
Telephone Number	:	706-322-9313
Fax Number	:	706-322-9314

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ASHISH JAIN
Credential	:	M.D.
Telephone Number	:	310-471-5852

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	04/08/2008

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