Basic Information
| Provider Information | |||||||||
| NPI: | 1841493863 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEHIGH VALLEY ANESTHESIA SERVICES, P. C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 S CEDAR CREST BLVD STE 301 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181036258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104028896 | ||||||||
| FaxNumber: | 6104029029 | ||||||||
| Practice Location | |||||||||
| Address1: | 1245 S CEDAR CREST BLVD STE 301 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181036258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104028896 | ||||||||
| FaxNumber: | 6104029029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | SHELLY | ||||||||
| AuthorizedOfficialFirstName: | IRIS | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS MANGER | ||||||||
| AuthorizedOfficialTelephone: | 6104029082 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CMM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 2031873000 | 01 | PA | IBC | OTHER | 0018815170017 | 05 | PA | MEDICAID | 1338442 | 01 | PA | HIGHMARK | OTHER | 7748295 | 01 | PA | AETNA | OTHER | 02353700 | 01 | PA | CAPITAL ADVANTAGE | OTHER |