Provider Demographics
NPI:1689983116
Name:AMBULATORY ANESTHESIA SOLUTIONS
Entity Type:Organization
Organization Name:AMBULATORY ANESTHESIA SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLD
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:248-470-9986
Mailing Address - Street 1:64 STARR DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1646
Mailing Address - Country:US
Mailing Address - Phone:248-470-9986
Mailing Address - Fax:248-565-2495
Practice Address - Street 1:64 STARR DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1646
Practice Address - Country:US
Practice Address - Phone:248-470-9986
Practice Address - Fax:248-565-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704226348367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704226348OtherNOLD LICENSE NUMBER