Basic Information
| Provider Information | |||||||||
| NPI: | 1609805407 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMFORT SEDATION LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9420 KEY WEST AVE | ||||||||
| Address2: | 104 A | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208503334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018380437 | ||||||||
| FaxNumber: | 3018380439 | ||||||||
| Practice Location | |||||||||
| Address1: | 9420 KEY WEST AVE | ||||||||
| Address2: | 104 A | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208503334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018380437 | ||||||||
| FaxNumber: | 3018380439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KEARNEY | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3018380437 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.