Basic Information
| Provider Information | |||||||||
| NPI: | 1457432791 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIAN ANESTHESIA ASSOC INC PS | ||||||||
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| OtherOrganizationName: | PHYSICIANS ANESTHESIA ASSOC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 406 S 30TH AVE STE 202 | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099721051 | ||||||||
| FaxNumber: | 5099724166 | ||||||||
| Practice Location | |||||||||
| Address1: | 406 S 30TH AVE STE 202 | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099721051 | ||||||||
| FaxNumber: | 5099724166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 12/17/2007 | ||||||||
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| AuthorizedOfficialLastName: | BEARD | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5099721051 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 7044969 | 05 | WA | MEDICAID | CD4327 | 01 | WA | RAILROAD MEDICARE | OTHER |