Basic Information
| Provider Information | |||||||||
| NPI: | 1609943547 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KANE ANESTHESIOLOGY PROFESSIONAL SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4372 ROUTE 6 | ||||||||
| Address2: | |||||||||
| City: | KANE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 167353060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148378585 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4372 ROUTE 6 | ||||||||
| Address2: | |||||||||
| City: | KANE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 167353060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148378585 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 04/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | ABBASSI | ||||||||
| AuthorizedOfficialFirstName: | SHAHRAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8148378585 | ||||||||
| IsSoleProprietor: | |||||||||
| 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 | MD0446271 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 05055 | 01 | PA | UPMC GROUP NUMBER | OTHER | 1520061 | 01 | PA | HIGHMARK BLUE SHIELD GRP | OTHER | 0019607640001 | 05 | PA | MEDICAID |