Provider Demographics
NPI:1629226873
Name:SOUTHFIELD ANESTHESIA, L.L.C.
Entity Type:Organization
Organization Name:SOUTHFIELD ANESTHESIA, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:AHLBRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-741-1414
Mailing Address - Street 1:2690 SOUTHFIELD DRIVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4510
Mailing Address - Country:US
Mailing Address - Phone:717-741-1414
Mailing Address - Fax:717-741-4774
Practice Address - Street 1:2690 SOUTHFIELD DRIVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4510
Practice Address - Country:US
Practice Address - Phone:717-741-1414
Practice Address - Fax:717-741-4774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2015-12-07
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
PA254646OtherUNISON HEALTH PLAN
PA1022119000001OtherMEDICAL ASSISTANCE
PA139494OtherMEDICARE
PA002072433OtherBLUE SHIELD
PA50081121OtherCAPITAL BLUECROSS
GADO3335OtherRAILROAD MEDICARE