Basic Information
| Provider Information | |||||||||
| NPI: | 1932482098 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ESSENTIAL ANESTHESIA SERVICES, PLC | ||||||||
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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: | 264 W MAPLE RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480845458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482449578 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2011 | ||||||||
| LastUpdateDate: | 09/26/2011 | ||||||||
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| AuthorizedOfficialLastName: | STOOPS | ||||||||
| AuthorizedOfficialFirstName: | CHAR | ||||||||
| AuthorizedOfficialMiddleName: | EVERETT | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2482449578 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | D62587 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.