Provider Demographics
NPI:1073731436
Name:SURGICAL ANESTHESIA OF GETTYSBURG LLC
Entity type:Organization
Organization Name:SURGICAL ANESTHESIA OF GETTYSBURG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIBAUDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-446-1417
Mailing Address - Street 1:PO BOX #8500 LOCKBOX #2652
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-2652
Mailing Address - Country:US
Mailing Address - Phone:866-259-1462
Mailing Address - Fax:706-650-1034
Practice Address - Street 1:250 FAME AVENUE
Practice Address - Street 2:SUITE 130
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1576
Practice Address - Country:US
Practice Address - Phone:866-259-1462
Practice Address - Fax:706-650-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA113121Medicare PIN