Basic Information
| Provider Information | |||||||||
| NPI: | 1407947617 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OFFICE BASED ANESTHESIA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 ROUTE 25A | ||||||||
| Address2: | EMPLOYEE SERVICE BLDG | ||||||||
| City: | SMITHTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318623540 | ||||||||
| FaxNumber: | 6318623604 | ||||||||
| Practice Location | |||||||||
| Address1: | 48 ROUTE 25A | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SMITHTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117871431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318623413 | ||||||||
| FaxNumber: | 6318623604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 03/25/2015 | ||||||||
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| AuthorizedOfficialLastName: | TURNER | ||||||||
| AuthorizedOfficialFirstName: | LANCE | ||||||||
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| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 6318623538 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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.