Provider Demographics
NPI:1346295987
Name:WATERVILLE ANESTHESIA ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:WATERVILLE ANESTHESIA ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-872-1136
Mailing Address - Street 1:44 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6673
Mailing Address - Country:US
Mailing Address - Phone:207-872-1136
Mailing Address - Fax:207-872-1536
Practice Address - Street 1:149 NORTH ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4974
Practice Address - Country:US
Practice Address - Phone:207-872-1270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1044577OtherAETNA
ME=========OtherEBPA
ME=========OtherHEALTHNET
ME=========OtherANTHEM
ME=========OtherCIGNA
ME=========OtherHARVARD
ME=========OtherCIGNA