Provider Demographics
NPI:1659574705
Name:LAURA GOODRICH ANESTHESIA SERVICES INC
Entity Type:Organization
Organization Name:LAURA GOODRICH ANESTHESIA SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-322-2426
Mailing Address - Street 1:PO BOX 12348
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24024-2348
Mailing Address - Country:US
Mailing Address - Phone:866-224-2413
Mailing Address - Fax:540-776-9615
Practice Address - Street 1:1 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134-1932
Practice Address - Country:US
Practice Address - Phone:866-224-2413
Practice Address - Fax:540-776-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty