Provider Demographics
NPI:1104867563
Name:ST. MARYS ANESTHESIOLOGY GROUP, L.P.
Entity Type:Organization
Organization Name:ST. MARYS ANESTHESIOLOGY GROUP, L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PISTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-834-7065
Mailing Address - Street 1:1376 BUCKTAIL RD
Mailing Address - Street 2:
Mailing Address - City:ST MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3212
Mailing Address - Country:US
Mailing Address - Phone:814-834-7065
Mailing Address - Fax:
Practice Address - Street 1:1376 BUCKTAIL RD
Practice Address - Street 2:
Practice Address - City:ST MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3212
Practice Address - Country:US
Practice Address - Phone:814-834-7065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014543500001Medicaid
PA1014543500001Medicaid