Basic Information
| Provider Information | |||||||||
| NPI: | 1821078197 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL PA ANESTHESIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 656 | ||||||||
| Address2: | |||||||||
| City: | SUNBURY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5709880925 | ||||||||
| FaxNumber: | 5709880919 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 N 11TH ST | ||||||||
| Address2: | |||||||||
| City: | SUNBURY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5709880925 | ||||||||
| FaxNumber: | 5709880919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FURTADO | ||||||||
| AuthorizedOfficialFirstName: | FRANCISCO | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5709880925 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHYSICIAN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD043143L | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0012632940003 | 05 | PA | MEDICAID |