Provider Demographics
NPI:1184045866
Name:SUPERIOR ANESTHESIA LLC
Entity Type:Organization
Organization Name:SUPERIOR ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARYCHEWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-901-1990
Mailing Address - Street 1:255 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2218
Mailing Address - Country:US
Mailing Address - Phone:517-787-6440
Mailing Address - Fax:517-787-4146
Practice Address - Street 1:ONE CORNERSTONE DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1321
Practice Address - Country:US
Practice Address - Phone:215-901-1990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPENDINGMedicare PIN