Provider Demographics
NPI:1851599559
Name:R M ANESTHESIA SERVICES PLLC
Entity Type:Organization
Organization Name:R M ANESTHESIA SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE ANESTHETIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MILDES
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:425-672-7275
Mailing Address - Street 1:708 212TH PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-8606
Mailing Address - Country:US
Mailing Address - Phone:425-672-7275
Mailing Address - Fax:425-744-0117
Practice Address - Street 1:708 212TH PL SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-8606
Practice Address - Country:US
Practice Address - Phone:425-672-7275
Practice Address - Fax:425-744-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA025804 30004423261QA1903X
WAAP30004423367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8866266Medicare PIN
WAG8866265Medicare PIN