Provider Demographics
NPI:1013950799
Name:ADIRONDACK ANESTHESIA SERVICES, PC
Entity Type:Organization
Organization Name:ADIRONDACK ANESTHESIA SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC/TREAS
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-891-2660
Mailing Address - Street 1:PO BOX 890
Mailing Address - Street 2:253 COUNTY ROUTE 47
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-0890
Mailing Address - Country:US
Mailing Address - Phone:518-891-2660
Mailing Address - Fax:518-891-2663
Practice Address - Street 1:253 COUNTY ROUTE 47
Practice Address - Street 2:SUITE 890
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-0890
Practice Address - Country:US
Practice Address - Phone:518-891-2660
Practice Address - Fax:518-891-2663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00903902Medicaid
NY39983AMedicare ID - Type UnspecifiedMEDICARE GROUP