Basic Information
| Provider Information | |||||||||
| NPI: | 1679521355 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIOLOGY MANAGEMENT INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 W MAPLE AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | ENID | ||||||||
| State: | OK | ||||||||
| PostalCode: | 737014026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802423003 | ||||||||
| FaxNumber: | 5802333279 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 W MAPLE AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | ENID | ||||||||
| State: | OK | ||||||||
| PostalCode: | 737014026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802423003 | ||||||||
| FaxNumber: | 5802333279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | PHILLIPS | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5802423003 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | CS1359 | 01 | OK | MEDICARE RR | OTHER |