Provider Demographics
NPI:1598268666
Name:KBO ANESTHESIA PLLC
Entity Type:Organization
Organization Name:KBO ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-312-5026
Mailing Address - Street 1:3637 NW BYRON ST
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9127
Mailing Address - Country:US
Mailing Address - Phone:301-312-5026
Mailing Address - Fax:
Practice Address - Street 1:3637 NW BYRON ST
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9127
Practice Address - Country:US
Practice Address - Phone:301-312-5026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60321448207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty