Provider Demographics
NPI:1326350406
Name:MEDICAL ANESTHESIA, INC.
Entity Type:Organization
Organization Name:MEDICAL ANESTHESIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:KW
Authorized Official - Last Name:CHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-726-6441
Mailing Address - Street 1:PO BOX 17128
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-0128
Mailing Address - Country:US
Mailing Address - Phone:866-726-6441
Mailing Address - Fax:
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:C/O MEDICAL STAFF - ANESTHESIA
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2402
Practice Address - Country:US
Practice Address - Phone:866-726-6644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD802207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty