Basic Information
| Provider Information | |||||||||
| NPI: | 1720035827 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROFESSIONAL ANESTHESIA SERVICE,INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1506 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253251506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043440096 | ||||||||
| FaxNumber: | 3043424725 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 ROANE ST | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253022334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043440096 | ||||||||
| FaxNumber: | 3043424725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 02/17/2009 | ||||||||
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| AuthorizedOfficialLastName: | MURTHY | ||||||||
| AuthorizedOfficialFirstName: | SRINIVAS | ||||||||
| AuthorizedOfficialMiddleName: | H, | ||||||||
| AuthorizedOfficialTitleorPosition: | M.D. | ||||||||
| AuthorizedOfficialTelephone: | 3043440096 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 18176 | WV | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.