Basic Information
| Provider Information | |||||||||
| NPI: | 1205103306 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPECTRUM ANESTHESIA & PAIN MANAGEMENT SERVICES, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 S EXECUTIVE DR | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530054257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627874026 | ||||||||
| FaxNumber: | 2627826040 | ||||||||
| Practice Location | |||||||||
| Address1: | 1739 SPRING CREEK LANE SUITE 100 | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153018143 | ||||||||
| FaxNumber: | 6153018152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2011 | ||||||||
| LastUpdateDate: | 11/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | BAKER | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2627874026 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 20840 | WY | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 40364 | MT | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.