Provider Demographics
NPI:1538105010
Name:CAPITAL AREA ANESTHESIA PC
Entity Type:Organization
Organization Name:CAPITAL AREA ANESTHESIA PC
Other - Org Name:LANSING ANESTHESIOLOGISTS PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHONG
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-482-2118
Mailing Address - Street 1:405 W GREENLAWN AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-2898
Mailing Address - Country:US
Mailing Address - Phone:517-482-2118
Mailing Address - Fax:517-482-6280
Practice Address - Street 1:405 W GREENLAWN AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-2898
Practice Address - Country:US
Practice Address - Phone:517-482-2118
Practice Address - Fax:517-482-6280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207LP2900X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C36012006Medicare ID - Type UnspecifiedINDIVIDUAL
MI0C36012023Medicare ID - Type UnspecifiedINDIVIDUAL
MI0C36012004Medicare ID - Type UnspecifiedINDIVIDUAL
MI0C36012022Medicare ID - Type UnspecifiedINDIVIDUAL
MI0C36012027Medicare ID - Type UnspecifiedINDIVIDUAL
MI0C36012Medicare ID - Type UnspecifiedGROUP
MI0C36012001Medicare ID - Type UnspecifiedINDIVIDUAL
MI0C36012011Medicare ID - Type UnspecifiedINDIVIDUAL
MI0C36012012Medicare ID - Type UnspecifiedINDIVIDUAL
MI0C36012024Medicare ID - Type UnspecifiedINDIVIDUAL
MI0C36012025Medicare ID - Type UnspecifiedINDIVIDUAL
MI0C36012028Medicare PIN
MI0C36012016Medicare ID - Type UnspecifiedINDIVIDUAL
MI0C36012018Medicare ID - Type UnspecifiedINDIVIDUAL
MI0C360120-03Medicare ID - Type UnspecifiedINDIVIDUAL
MI0C36012007Medicare ID - Type UnspecifiedINDIVIDUAL
MI0C36012020Medicare ID - Type UnspecifiedINDIVIDUAL