Basic Information
| Provider Information | |||||||||
| NPI: | 1093768830 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPRINGFIELD ANESTHESIA SERVICE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 983122 | ||||||||
| Address2: | CLIENT ID 800309 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022983122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814077713 | ||||||||
| FaxNumber: | 7814070998 | ||||||||
| Practice Location | |||||||||
| Address1: | 908 ALLEN ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011182533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814077713 | ||||||||
| FaxNumber: | 7814070998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 05/24/2016 | ||||||||
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| AuthorizedOfficialLastName: | BAILIN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 4137967494 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.