Provider Demographics
NPI:1477652279
Name:MOBILE ANESTHESIA SERVICE CONCEPTS, LLC
Entity type:Organization
Organization Name:MOBILE ANESTHESIA SERVICE CONCEPTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:267-226-0050
Mailing Address - Street 1:84 WOODHILL ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940
Mailing Address - Country:US
Mailing Address - Phone:267-226-0050
Mailing Address - Fax:215-504-8334
Practice Address - Street 1:9525 FRANKFORD AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114
Practice Address - Country:US
Practice Address - Phone:215-333-9696
Practice Address - Fax:215-333-8514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007111L207L00000X
NJ207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0661247000OtherKEYSTONE
PA0661247000OtherPERSONAL CHOICE
PA2641124000OtherAMERIHEALTH PPO
PA49665OtherBLUE SHIELD PPO
PA01414076Medicaid
PA49665OtherBLUE SHIELD FEDERAL PROGR
PADE49665Medicare ID - Type Unspecified
PA01414076Medicaid