Provider Demographics
NPI:1740513530
Name:SAND ANESTHESIA GROUP
Entity type:Organization
Organization Name:SAND ANESTHESIA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:HASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-761-7223
Mailing Address - Street 1:PO BOX 1096
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35807-0096
Mailing Address - Country:US
Mailing Address - Phone:800-436-1018
Mailing Address - Fax:559-354-4235
Practice Address - Street 1:3754 HIGHWAY 90 STE 120
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-1097
Practice Address - Country:US
Practice Address - Phone:877-761-7223
Practice Address - Fax:251-217-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69740207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGOtherMEDICARE