Provider Demographics
NPI:1790907871
Name:JHT ANESTHESIA SERVICES, LLC
Entity Type:Organization
Organization Name:JHT ANESTHESIA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HETHERINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:410-372-0563
Mailing Address - Street 1:6009 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2201
Mailing Address - Country:US
Mailing Address - Phone:410-372-0563
Mailing Address - Fax:410-372-0564
Practice Address - Street 1:6009 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2201
Practice Address - Country:US
Practice Address - Phone:410-372-0563
Practice Address - Fax:410-372-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR066163367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty