Provider Demographics
NPI:1972040020
Name:WILSHIRE ANESTHESIA ASSOCIATES LLC
Entity Type:Organization
Organization Name:WILSHIRE ANESTHESIA ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:W
Authorized Official - Last Name:POLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-345-6900
Mailing Address - Street 1:401 COMMERCE ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-2446
Mailing Address - Country:US
Mailing Address - Phone:615-345-6900
Mailing Address - Fax:
Practice Address - Street 1:500 S VIRGIL AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1446
Practice Address - Country:US
Practice Address - Phone:213-738-6090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty