Provider Demographics
NPI:1043373954
Name:WHITE MOUNTAIN ANESTHESIA, PLLC
Entity Type:Organization
Organization Name:WHITE MOUNTAIN ANESTHESIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAYNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAUGLUM
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:603-356-5461
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-0416
Mailing Address - Country:US
Mailing Address - Phone:603-356-5461
Mailing Address - Fax:603-356-7651
Practice Address - Street 1:3073 WHITE MOUNTAIN HWY
Practice Address - Street 2:ANESTHESIOLOGY DEPARTMENT
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5111
Practice Address - Country:US
Practice Address - Phone:603-356-5461
Practice Address - Fax:603-356-7651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE6969Medicare ID - Type Unspecified