Provider Demographics
NPI:1053511550
Name:PROFESSIONAL ANESTHESIA SERVICES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL ANESTHESIA SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:T
Authorized Official - Last Name:FLURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-570-3889
Mailing Address - Street 1:193 W PADDOCK CIR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1031
Mailing Address - Country:US
Mailing Address - Phone:410-647-5210
Mailing Address - Fax:410-647-6273
Practice Address - Street 1:193 W PADDOCK CIR
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-1031
Practice Address - Country:US
Practice Address - Phone:410-647-5210
Practice Address - Fax:410-647-6273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6877OtherCAREFIRST BCBS
MDKE09PROtherCAREFIRST BCBS
MDG00015Medicare PIN
MD6877OtherCAREFIRST BCBS