Provider Demographics
NPI:1144408915
Name:PUGET SOUND ANESTHESIA SERVICE, PLLC
Entity Type:Organization
Organization Name:PUGET SOUND ANESTHESIA SERVICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:KROLL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:206-654-9025
Mailing Address - Street 1:2029 161ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-7771
Mailing Address - Country:US
Mailing Address - Phone:206-654-9025
Mailing Address - Fax:
Practice Address - Street 1:1600 116TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3014
Practice Address - Country:US
Practice Address - Phone:425-454-5133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004363367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9605668Medicaid
WA0063386OtherLABOR AND INDUSTRIES
WAKR4632OtherKCMBS
WA000104108Medicare UPIN