Provider Demographics
NPI:1831170067
Name:ANESTHESIA ASSOCIATES OF EDMOND, PLLC
Entity type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF EDMOND, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:WEDDLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:918-728-6194
Mailing Address - Street 1:4500 S GARNETT RD
Mailing Address - Street 2:SUITE 919
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5229
Mailing Address - Country:US
Mailing Address - Phone:918-728-6194
Mailing Address - Fax:918-664-2521
Practice Address - Street 1:1 S BRYANT AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6309
Practice Address - Country:US
Practice Address - Phone:918-728-6194
Practice Address - Fax:918-664-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-05
Last Update Date:2007-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKDD9011Medicare PIN
OKCG3266Medicare PIN