Provider Demographics
NPI:1629034624
Name:ANESTHESIA SERVICES OF DECATUR PC
Entity Type:Organization
Organization Name:ANESTHESIA SERVICES OF DECATUR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELASHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-221-7482
Mailing Address - Street 1:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35631-0757
Mailing Address - Country:US
Mailing Address - Phone:256-764-9697
Mailing Address - Fax:256-764-9699
Practice Address - Street 1:1201 7TH ST SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3337
Practice Address - Country:US
Practice Address - Phone:256-341-2000
Practice Address - Fax:256-350-2609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI925Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
ALE375Medicare ID - Type UnspecifiedMEDICARE GROUP
ALJ722Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER