Provider Demographics
NPI:1417962200
Name:PHYSICIANS ANESTHESIA SERVICE PLLC
Entity Type:Organization
Organization Name:PHYSICIANS ANESTHESIA SERVICE PLLC
Other - Org Name:U.S. ANESTHESIA PARTNERS OF WASHINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REVENUE
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER-BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-261-4271
Mailing Address - Street 1:600 BROADWAY STE 270
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5392
Mailing Address - Country:US
Mailing Address - Phone:206-381-0269
Mailing Address - Fax:206-829-2083
Practice Address - Street 1:600 BROADWAY STE 270
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5392
Practice Address - Country:US
Practice Address - Phone:206-381-0269
Practice Address - Fax:206-829-2083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600084653207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7815301Medicaid
WA8157968Medicaid
G000156100Medicare PIN
CD5550Medicare PIN