Provider Demographics
NPI:1477536779
Name:KEYSTONE ANESTHESIA, LLC
Entity Type:Organization
Organization Name:KEYSTONE ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVIID
Authorized Official - Middle Name:A
Authorized Official - Last Name:FEMOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-677-6700
Mailing Address - Street 1:3744 STATE ROUTE 257
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-3318
Mailing Address - Country:US
Mailing Address - Phone:814-677-6700
Mailing Address - Fax:814-677-6776
Practice Address - Street 1:3744 STATE ROUTE 257
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-3318
Practice Address - Country:US
Practice Address - Phone:814-677-6638
Practice Address - Fax:814-676-1593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA580913OtherBLUE SHIELD
PA043666Medicare ID - Type UnspecifiedKEYSTONE ANESTHEISA