Provider Demographics
NPI:1588655906
Name:LAKES ANESTHESIA
Entity type:Organization
Organization Name:LAKES ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MERCED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-581-6403
Mailing Address - Street 1:PO BOX 11626
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98411-6626
Mailing Address - Country:US
Mailing Address - Phone:253-565-9765
Mailing Address - Fax:253-584-6544
Practice Address - Street 1:11315 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-581-6403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty