Provider Demographics
NPI:1659458149
Name:OUTPATIENT ANESTHESIA SERVICES, PLLC
Entity Type:Organization
Organization Name:OUTPATIENT ANESTHESIA SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER DESIGNEE
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:FLACCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-244-1212
Mailing Address - Street 1:PO BOX 5908
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-0408
Mailing Address - Country:US
Mailing Address - Phone:206-244-1212
Mailing Address - Fax:206-244-1223
Practice Address - Street 1:1100 PACIFIC AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4261
Practice Address - Country:US
Practice Address - Phone:425-339-2433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7119225Medicaid
WA8785OUOtherREGENCE GROUP PIN
WA0175855OtherL&I GROUP PIN
WAG8803559Medicare PIN
WA8785OUOtherREGENCE GROUP PIN