Basic Information
| Provider Information | |||||||||
| NPI: | 1831443373 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WLSC ANESTHESIA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 COMMERCE ST | ||||||||
| Address2: | STE 740 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372192446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153456879 | ||||||||
| FaxNumber: | 6153456879 | ||||||||
| Practice Location | |||||||||
| Address1: | 10200 W INNOVATION DR | ||||||||
| Address2: | STE 700 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532264825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043029196 | ||||||||
| FaxNumber: | 4147734666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2012 | ||||||||
| LastUpdateDate: | 01/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | HOLST | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT BOARD OF MANAGERS | ||||||||
| AuthorizedOfficialTelephone: | 6153456899 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 |
No ID Information.