Provider Demographics
NPI:1265491120
Name:ANESTHESIA BY REQUEST, PC
Entity Type:Organization
Organization Name:ANESTHESIA BY REQUEST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:WENDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-210-3682
Mailing Address - Street 1:3827 HONORS WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9147
Mailing Address - Country:US
Mailing Address - Phone:706-210-3682
Mailing Address - Fax:
Practice Address - Street 1:3827 HONORS WAY
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-9147
Practice Address - Country:US
Practice Address - Phone:706-210-3682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040976207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty