Provider Demographics
NPI:1972994820
Name:PROFESSIONAL ANESTHESIA SERVICES OF NORTH AMERICA P.C.
Entity Type:Organization
Organization Name:PROFESSIONAL ANESTHESIA SERVICES OF NORTH AMERICA P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:D'AMICO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:610-366-9536
Mailing Address - Street 1:PO BOX 65008
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-5008
Mailing Address - Country:US
Mailing Address - Phone:610-366-9536
Mailing Address - Fax:
Practice Address - Street 1:2310 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8920
Practice Address - Country:US
Practice Address - Phone:610-861-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA397968Medicare PIN