Basic Information
| Provider Information | |||||||||
| NPI: | 1629226873 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTHFIELD ANESTHESIA, L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2690 SOUTHFIELD DRIVE | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174034510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177411414 | ||||||||
| FaxNumber: | 7177414774 | ||||||||
| Practice Location | |||||||||
| Address1: | 2690 SOUTHFIELD DRIVE | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174034510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177411414 | ||||||||
| FaxNumber: | 7177414774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2008 | ||||||||
| LastUpdateDate: | 12/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | AHLBRANDT | ||||||||
| AuthorizedOfficialFirstName: | DUANE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | MD/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7177411414 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | 254646 | 01 | PA | UNISON HEALTH PLAN | OTHER | 1022119000001 | 01 | PA | MEDICAL ASSISTANCE | OTHER | 139494 | 01 | PA | MEDICARE | OTHER | 002072433 | 01 | PA | BLUE SHIELD | OTHER | 50081121 | 01 | PA | CAPITAL BLUECROSS | OTHER | DO3335 | 01 | GA | RAILROAD MEDICARE | OTHER |