Provider Demographics
NPI:1235773623
Name:AVANIA ANESTHESIA PC
Entity Type:Organization
Organization Name:AVANIA ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:912-223-1870
Mailing Address - Street 1:1408 11TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-3304
Mailing Address - Country:US
Mailing Address - Phone:814-414-3891
Mailing Address - Fax:
Practice Address - Street 1:2026 STILLWATER DR
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-6200
Practice Address - Country:US
Practice Address - Phone:724-449-2762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty