Provider Demographics
NPI:1063487056
Name:ANESTHESIA SERVICE INC PS
Entity Type:Organization
Organization Name:ANESTHESIA SERVICE INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAR
Authorized Official - Middle Name:L
Authorized Official - Last Name:MELDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-466-2542
Mailing Address - Street 1:PO BOX 2329
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-7329
Mailing Address - Country:US
Mailing Address - Phone:360-336-6517
Mailing Address - Fax:360-466-2682
Practice Address - Street 1:1415 E KINCAID ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4126
Practice Address - Country:US
Practice Address - Phone:360-336-6517
Practice Address - Fax:360-466-2682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0743OtherREGENCE BLUE SHIELD
WACD2096OtherRAILROAD MEDICARE
WA0061300OtherDEPT OF LABOR & INDUSTRIE
WA22989001OtherGROUP HEALTH
WA7844400Medicaid
WATRICAREOtherA001
WA=========OtherPREMERA BLUE CROSS