Provider Demographics
NPI:1033271481
Name:AMBULATORY ANESTHESIA CONSULTANTS, PC
Entity Type:Organization
Organization Name:AMBULATORY ANESTHESIA CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-578-1800
Mailing Address - Street 1:PO BOX 72483
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30007-2483
Mailing Address - Country:US
Mailing Address - Phone:770-578-1800
Mailing Address - Fax:
Practice Address - Street 1:1077 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-2073
Practice Address - Country:US
Practice Address - Phone:770-578-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACH5187OtherRAILROAD MEDICARE
GAGRP4641Medicare ID - Type Unspecified