Provider Demographics
NPI:1093768830
Name:SPRINGFIELD ANESTHESIA SERVICE, INC.
Entity Type:Organization
Organization Name:SPRINGFIELD ANESTHESIA SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-796-7494
Mailing Address - Street 1:PO BOX 983122
Mailing Address - Street 2:CLIENT ID 800309
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02298-3122
Mailing Address - Country:US
Mailing Address - Phone:781-407-7713
Mailing Address - Fax:781-407-0998
Practice Address - Street 1:908 ALLEN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-2533
Practice Address - Country:US
Practice Address - Phone:781-407-7713
Practice Address - Fax:781-407-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM11413Medicare PIN