Provider Demographics
NPI:1568946812
Name:CSP ANESTHESIA LLC
Entity type:Organization
Organization Name:CSP ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:888-408-0200
Mailing Address - Street 1:PO BOX 4096
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-0217
Mailing Address - Country:US
Mailing Address - Phone:888-408-0200
Mailing Address - Fax:
Practice Address - Street 1:130 E MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2784
Practice Address - Country:US
Practice Address - Phone:888-408-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-22
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty