Provider Demographics
NPI:1134677396
Name:ANESTHESIA SERVICES ASSOCIATES PLLC
Entity Type:Organization
Organization Name:ANESTHESIA SERVICES ASSOCIATES PLLC
Other - Org Name:COMPREHENSIVE PAIN SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-842-8339
Mailing Address - Street 1:PO BOX 440210
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0210
Mailing Address - Country:US
Mailing Address - Phone:336-842-8339
Mailing Address - Fax:
Practice Address - Street 1:500 PINEVIEW DR
Practice Address - Street 2:STE 205
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3812
Practice Address - Country:US
Practice Address - Phone:336-310-6115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty