Basic Information
| Provider Information | |||||||||
| NPI: | 1306016480 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEHIGH VALLEY ANESTHESIA SERVICES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 S CEDAR CREST BLVD | ||||||||
| Address2: | #301 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181036258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104029080 | ||||||||
| FaxNumber: | 6104029029 | ||||||||
| Practice Location | |||||||||
| Address1: | 1245 S CEDAR CREST BLVD | ||||||||
| Address2: | #301 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181036258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104029080 | ||||||||
| FaxNumber: | 6104029029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2008 | ||||||||
| LastUpdateDate: | 05/17/2010 | ||||||||
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| AuthorizedOfficialLastName: | SHELLY | ||||||||
| AuthorizedOfficialFirstName: | IRIS | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6104029082 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD057251L | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0018815170 | 05 | PA | MEDICAID | 1334876 | 01 | PA | HIGHMARK | OTHER | 222730 | 01 | PA | FIRST HEALTH PRIORITY | OTHER | 30000056 | 01 | PA | KEYSTONE MERCY | OTHER | 204757 | 01 | PA | HEALTH AMERICA | OTHER | 1522740 | 01 | PA | GATEWAY | OTHER | 2028161000 | 01 | PA | IBC | OTHER | 02353700 | 01 | PA | CAPITAL ADVANTAGE | OTHER |