Provider Demographics
NPI:1821347949
Name:VAVRA ANESTHESIA SERVICE INC
Entity Type:Organization
Organization Name:VAVRA ANESTHESIA SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:VAVRA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:425-392-8803
Mailing Address - Street 1:PO BOX 1024
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-0039
Mailing Address - Country:US
Mailing Address - Phone:425-392-8803
Mailing Address - Fax:425-392-8944
Practice Address - Street 1:21453 SE 35TH WAY
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-6240
Practice Address - Country:US
Practice Address - Phone:425-392-8803
Practice Address - Fax:425-392-8944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005421367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6228OtherREGENCE
WA108803OtherLABOR & INDUSTRIES
WA108803OtherLABOR & INDUSTRIES
WAAB324048Medicare UPIN