Basic Information
| Provider Information | |||||||||
| NPI: | 1790816254 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMBULATORY ANESTHESIA SERVICES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1602 PHYSICIANS DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284017363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104421100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1602 PHYSICIANS DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284017363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104421100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SHAKAR | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE COMMITTEE CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 9104421100 | ||||||||
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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 | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.