Provider Demographics
NPI:1386631125
Name:ANESTHESIOLOGY CONSULTANTS OF WALLA WALLA PC
Entity Type:Organization
Organization Name:ANESTHESIOLOGY CONSULTANTS OF WALLA WALLA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:G
Authorized Official - Last Name:CAUDILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-529-1284
Mailing Address - Street 1:PO BOX 1663
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0031
Mailing Address - Country:US
Mailing Address - Phone:509-529-1284
Mailing Address - Fax:509-522-1798
Practice Address - Street 1:1277 WOODWARD CANYON RD
Practice Address - Street 2:
Practice Address - City:TOUCHET
Practice Address - State:WA
Practice Address - Zip Code:99360-9709
Practice Address - Country:US
Practice Address - Phone:509-529-1284
Practice Address - Fax:509-522-1798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150622Medicaid
WA7084999Medicaid
WACE2367OtherRAILROAD MEDICARE
WACE2367OtherRAILROAD MEDICARE