Provider Demographics
NPI:1326756370
Name:PAULSGROVE ANESTHESIA SERVICES PLLC
Entity Type:Organization
Organization Name:PAULSGROVE ANESTHESIA SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:PHAM
Authorized Official - Last Name:PAULSGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:405-312-6296
Mailing Address - Street 1:11410 RED ROCK RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5345
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11410 RED ROCK RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5345
Practice Address - Country:US
Practice Address - Phone:405-312-6296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty