Provider Demographics
NPI:1366496507
Name:CHAMPLAIN VALLEY MEDICAL ANESTHESIA SERVICES, PC
Entity Type:Organization
Organization Name:CHAMPLAIN VALLEY MEDICAL ANESTHESIA SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CURRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-563-5155
Mailing Address - Street 1:292 CUMBERLAND HEAD RD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6708
Mailing Address - Country:US
Mailing Address - Phone:518-563-5155
Mailing Address - Fax:
Practice Address - Street 1:75 BEEKMAN ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1438
Practice Address - Country:US
Practice Address - Phone:518-561-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
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
NY01339739Medicaid
NY53279AMedicare ID - Type Unspecified