Provider Demographics
NPI:1659748069
Name:SUSITNA ANESTHESIA ASSOCIATES
Entity Type:Organization
Organization Name:SUSITNA ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRYGG
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-227-0554
Mailing Address - Street 1:1708 SE 32ND PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5017
Mailing Address - Country:US
Mailing Address - Phone:907-227-0554
Mailing Address - Fax:
Practice Address - Street 1:1843 BOOTLEGGER COVE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-4222
Practice Address - Country:US
Practice Address - Phone:907-227-0554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5345207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty