Provider Demographics
NPI:1780603944
Name:WEST COAST ANESTHESIA PLLC
Entity type:Organization
Organization Name:WEST COAST ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHOVAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-780-6080
Mailing Address - Street 1:3597 HENRY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-6723
Mailing Address - Country:US
Mailing Address - Phone:231-780-6080
Mailing Address - Fax:231-780-6093
Practice Address - Street 1:1500 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1849
Practice Address - Country:US
Practice Address - Phone:231-739-3928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0F14537Medicare ID - Type UnspecifiedDOCTOR
MICE1916Medicare PIN
0M79550Medicare ID - Type UnspecifiedCRNA