Basic Information
| Provider Information | |||||||||
| NPI: | 1467779793 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED ANESTHESIOLOGY SERVICES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4860 | ||||||||
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| City: | MURRELLS INLET | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295762698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436512624 | ||||||||
| FaxNumber: | 8433574940 | ||||||||
| Practice Location | |||||||||
| Address1: | 8015 SHOAL CREEK BLVD | ||||||||
| Address2: | STE 118 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787578066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124855890 | ||||||||
| FaxNumber: | 8433574940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2010 | ||||||||
| LastUpdateDate: | 04/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | SCHEWEDA | ||||||||
| AuthorizedOfficialFirstName: | SHANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5124855890 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.