Provider Demographics
NPI:1134496086
Name:LANIPO VILLAGE ANESTHESIA LLC
Entity Type:Organization
Organization Name:LANIPO VILLAGE ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-721-2685
Mailing Address - Street 1:151 LANIPO DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3228
Mailing Address - Country:US
Mailing Address - Phone:808-721-2685
Mailing Address - Fax:808-263-1013
Practice Address - Street 1:151 LANIPO DR
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3228
Practice Address - Country:US
Practice Address - Phone:808-721-2685
Practice Address - Fax:808-263-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD05461207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty