Basic Information
| Provider Information | |||||||||
| NPI: | 1942201264 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGI-CENTER ANESTHESIOLOGISTS, P.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 99 EAST RIVER DR | ||||||||
| Address2: | 5TH FL | ||||||||
| City: | EAST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061087301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602824022 | ||||||||
| FaxNumber: | 8602890742 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 ROBBINS ST | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067082652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037556663 | ||||||||
| FaxNumber: | 2037569645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 11/28/2012 | ||||||||
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| AuthorizedOfficialLastName: | TURLEY | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2037556663 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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 | CT | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 4074266 | 05 | CT | MEDICAID | 004074266 | 05 | CT | MEDICAID |