Provider Demographics
NPI:1184751380
Name:RAWLS ANESTHESIA SERVICE, INC
Entity type:Organization
Organization Name:RAWLS ANESTHESIA SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAWLS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:405-715-3610
Mailing Address - Street 1:3324 FRENCH PARK DR
Mailing Address - Street 2:STE. D
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-7269
Mailing Address - Country:US
Mailing Address - Phone:405-715-3610
Mailing Address - Fax:405-715-3612
Practice Address - Street 1:3324 FRENCH PARK DR
Practice Address - Street 2:STE. D
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-7269
Practice Address - Country:US
Practice Address - Phone:405-715-3610
Practice Address - Fax:405-715-3612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0068167367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK464171909001OtherBCBS OF OKLAHOMA