Provider Demographics
NPI:1689445959
Name:PRESTIGE ANESTHESIA, PC
Entity Type:Organization
Organization Name:PRESTIGE ANESTHESIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:EAGLESON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-792-4090
Mailing Address - Street 1:4450 FASHION SQUARE BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-1251
Mailing Address - Country:US
Mailing Address - Phone:989-558-0734
Mailing Address - Fax:989-249-0227
Practice Address - Street 1:4450 FASHION SQUARE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-1251
Practice Address - Country:US
Practice Address - Phone:989-790-7950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty