Provider Demographics
NPI:1598221616
Name:MEDICAL ANESTHESIA SERVICES, LLC
Entity Type:Organization
Organization Name:MEDICAL ANESTHESIA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIBISLAVSKI
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA, DNP
Authorized Official - Phone:941-376-1242
Mailing Address - Street 1:3623 W HOWARD NICKELL RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5479
Mailing Address - Country:US
Mailing Address - Phone:941-376-1242
Mailing Address - Fax:
Practice Address - Street 1:3394 N FUTRALL DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4057
Practice Address - Country:US
Practice Address - Phone:479-582-3360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty