Basic Information
| Provider Information | |||||||||
| NPI: | 1689617953 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIA SOLUTIONS OF MOBILE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 610 | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217050610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666078693 | ||||||||
| FaxNumber: | 2405661680 | ||||||||
| Practice Location | |||||||||
| Address1: | 6801 AIRPORT BLVD | ||||||||
| Address2: | ANESTHESIA DEPARTMENT | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366083709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516313270 | ||||||||
| FaxNumber: | 2516313273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 01/31/2013 | ||||||||
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| AuthorizedOfficialLastName: | CHRISTIANSON | ||||||||
| AuthorizedOfficialFirstName: | CLARK | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2516331660 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 529912760 | 05 | AL | MEDICAID | 362602200 | 01 | US DEPARTMENT OF LABOR | OTHER | 01583765 | 05 | MS | MEDICAID |