Provider Demographics
NPI:1932131729
Name:GOETZ ANESTHESIA SERVICES, INC.
Entity Type:Organization
Organization Name:GOETZ ANESTHESIA SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-502-5005
Mailing Address - Street 1:505 CONCORD ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3564
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:443-502-5005
Practice Address - Street 1:505 CONCORD ST UNIT A
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3564
Practice Address - Country:US
Practice Address - Phone:443-502-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD426CGOOtherCAREFIRST MD
DCN023OtherCAREFIRST DC
DCN023OtherCAREFIRST DC