Provider Demographics
NPI:1689938144
Name:ASTORIA ANESTHESIOLOGY LLC
Entity Type:Organization
Organization Name:ASTORIA ANESTHESIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:AGUDELO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:478-787-9153
Mailing Address - Street 1:102 HICKORY STREET
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3047
Mailing Address - Country:US
Mailing Address - Phone:800-204-0099
Mailing Address - Fax:336-882-2216
Practice Address - Street 1:102 HICKORY STREET
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3047
Practice Address - Country:US
Practice Address - Phone:800-204-0099
Practice Address - Fax:336-882-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty