Provider Demographics
NPI:1437197332
Name:RAISIN VALLEY ANESTHESIA ASSOCIATES, PC
Entity Type:Organization
Organization Name:RAISIN VALLEY ANESTHESIA ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLY
Authorized Official - Middle Name:
Authorized Official - Last Name:POMPY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-240-5238
Mailing Address - Street 1:740 N MACOMB ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-7813
Mailing Address - Country:US
Mailing Address - Phone:734-240-5238
Mailing Address - Fax:734-240-5273
Practice Address - Street 1:740 N MACOMB ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-7813
Practice Address - Country:US
Practice Address - Phone:734-240-5238
Practice Address - Fax:734-240-5273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
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
OH=========-11OtherBWC
OH=========-11OtherBWC
MICM0052Medicare ID - Type UnspecifiedRAILROAD MEDICARE