Basic Information
| Provider Information | |||||||||
| NPI: | 1477846673 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AEPC ANESTHESIA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1753 W AVENUE J | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935349823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612060555 | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 COMMERCE ST | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372192446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153456900 | ||||||||
| FaxNumber: | 6156917214 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2011 | ||||||||
| LastUpdateDate: | 04/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | HOLST | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT BOARD OF MANAGERS | ||||||||
| AuthorizedOfficialTelephone: | 6153456900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.