Provider Demographics
NPI:1346327152
Name:MOUNTAINSIDE ANESTHESIA CONSULTANTS LLC
Entity Type:Organization
Organization Name:MOUNTAINSIDE ANESTHESIA CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPILLANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-299-5172
Mailing Address - Street 1:1300 RIDENOUR BLVD NW STE 300
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4402
Mailing Address - Country:US
Mailing Address - Phone:770-702-1806
Mailing Address - Fax:770-693-0810
Practice Address - Street 1:1266 HIGHWAY 515 S
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4872
Practice Address - Country:US
Practice Address - Phone:706-301-5434
Practice Address - Fax:706-301-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4634Medicare ID - Type UnspecifiedGROUP NUMBER