Basic Information
| Provider Information | |||||||||
| NPI: | 1962446781 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAPITOL ANESTHESIA SERVICES P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2854 HIGHWAY 55 | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | EAGAN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551211405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6518423344 | ||||||||
| FaxNumber: | 6518423391 | ||||||||
| Practice Location | |||||||||
| Address1: | 2854 HIGHWAY 55 | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | EAGAN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551211405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6518423344 | ||||||||
| FaxNumber: | 6518423391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 10/03/2007 | ||||||||
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| AuthorizedOfficialLastName: | THOMPSON | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6518423344 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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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.