Provider Demographics
NPI:1659346443
Name:ANESTHESIA PROFESSIONALS, INC.
Entity Type:Organization
Organization Name:ANESTHESIA PROFESSIONALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:GAUVIN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:401-826-8720
Mailing Address - Street 1:400 EAST 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4552
Mailing Address - Country:US
Mailing Address - Phone:888-209-0305
Mailing Address - Fax:952-442-3620
Practice Address - Street 1:78 FAUNCE CORNER RD UNIT 560
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1265
Practice Address - Country:US
Practice Address - Phone:888-209-0305
Practice Address - Fax:952-442-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2019-07-25
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
MA05459581OtherTRICARE
MAANM20356OtherBLUE CROSS OF MA
MAANM20356OtherBLUE CROSS OF MA
MA05459581OtherTRICARE