Provider Demographics
NPI:1700287232
Name:SIESTA ANESTHESIA SERVICES, LLC
Entity Type:Organization
Organization Name:SIESTA ANESTHESIA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:TAJ
Authorized Official - Middle Name:K
Authorized Official - Last Name:EUBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-376-3639
Mailing Address - Street 1:100 HARTSFIELD CENTER PKWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1341
Mailing Address - Country:US
Mailing Address - Phone:404-376-3639
Mailing Address - Fax:
Practice Address - Street 1:100 HARTSFIELD CENTER PKWY
Practice Address - Street 2:SUITE 500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30354-1341
Practice Address - Country:US
Practice Address - Phone:404-376-3639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty