Basic Information
| Provider Information | |||||||||
| NPI: | 1508598913 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VITAL ANESTHESIA SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 S 14TH ST STE 16180 | ||||||||
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| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796055015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256756466 | ||||||||
| FaxNumber: | 3256926030 | ||||||||
| Practice Location | |||||||||
| Address1: | 1714 E HUNDRED RD | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238363310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8046810556 | ||||||||
| FaxNumber: | 8044104619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2022 | ||||||||
| LastUpdateDate: | 06/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | BURTON | ||||||||
| AuthorizedOfficialFirstName: | JESSICA | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3256756466 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
| NPICertificationDate: | 06/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.