Provider Demographics
NPI:1396725024
Name:ISLAND ANESTHESIA SERVICES LLC
Entity type:Organization
Organization Name:ISLAND ANESTHESIA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:I
Authorized Official - Last Name:CZECHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-557-7443
Mailing Address - Street 1:PO BOX 421718
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29442-4203
Mailing Address - Country:US
Mailing Address - Phone:843-557-7443
Mailing Address - Fax:843-520-8094
Practice Address - Street 1:606 BLACK RIVER RD
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-3304
Practice Address - Country:US
Practice Address - Phone:843-527-7000
Practice Address - Fax:843-520-8094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGRP0383Medicaid
SCGRP0383Medicaid