Basic Information
| Provider Information | |||||||||
| NPI: | 1659458149 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OUTPATIENT ANESTHESIA SERVICES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5908 | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980060408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062441212 | ||||||||
| FaxNumber: | 2062441223 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 PACIFIC AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982014261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253392433 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FLACCO | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER DESIGNEE | ||||||||
| AuthorizedOfficialTelephone: | 2062441212 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 7119225 | 05 | WA | MEDICAID | 8785OU | 01 | WA | REGENCE GROUP PIN | OTHER | 0175855 | 01 | WA | L&I GROUP PIN | OTHER |