Provider Demographics
NPI:1306016480
Name:LEHIGH VALLEY ANESTHESIA SERVICES, PC
Entity Type:Organization
Organization Name:LEHIGH VALLEY ANESTHESIA SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-554-3604
Mailing Address - Street 1:1200 S CEDAR CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6202
Mailing Address - Country:US
Mailing Address - Phone:610-554-3604
Mailing Address - Fax:
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-554-3604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057251L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30000056OtherKEYSTONE MERCY
PA1334876OtherHIGHMARK
PA0018815170Medicaid
PA1522740OtherGATEWAY
PA02353700OtherCAPITAL ADVANTAGE
PA2028161000OtherIBC
PA222730OtherFIRST HEALTH PRIORITY
PA204757OtherHEALTH AMERICA
PA0018815170Medicaid