Basic Information
| Provider Information | |||||||||
| NPI: | 1326413576 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SRMC ANESTHESIA SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9048 SUGAR EST | ||||||||
| Address2: | |||||||||
| City: | ST THOMAS | ||||||||
| State: | VI | ||||||||
| PostalCode: | 008023634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3407768311 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9048 SUGAR EST | ||||||||
| Address2: | |||||||||
| City: | ST THOMAS | ||||||||
| State: | VI | ||||||||
| PostalCode: | 008023634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3407768311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2015 | ||||||||
| LastUpdateDate: | 02/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | NOTHNAGEL | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3407768311 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | VI GOVERNMENT HOSPITAL & HEALTH FACILITIES CORP | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.