Provider Demographics
NPI:1720035827
Name:PROFESSIONAL ANESTHESIA SERVICE,INC.
Entity Type:Organization
Organization Name:PROFESSIONAL ANESTHESIA SERVICE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:H,
Authorized Official - Last Name:MURTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-344-0096
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25325-1506
Mailing Address - Country:US
Mailing Address - Phone:304-344-0096
Mailing Address - Fax:304-342-4725
Practice Address - Street 1:110 ROANE ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2334
Practice Address - Country:US
Practice Address - Phone:304-344-0096
Practice Address - Fax:304-342-4725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18176207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVPR9216462Medicare ID - Type UnspecifiedMEDICARE