Provider Demographics
NPI:1336328293
Name:AMBULATORY SURGERY ANESTHESIA LLC
Entity Type:Organization
Organization Name:AMBULATORY SURGERY ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BHUVANENDRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:INDRAKRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-377-8252
Mailing Address - Street 1:PO BOX 8846
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27419-0846
Mailing Address - Country:US
Mailing Address - Phone:336-553-1659
Mailing Address - Fax:336-553-3994
Practice Address - Street 1:475 PHILIP BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-8737
Practice Address - Country:US
Practice Address - Phone:678-377-8252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty