Provider Demographics
NPI:1699075135
Name:MOBILE ANESTHESIA, PC
Entity type:Organization
Organization Name:MOBILE ANESTHESIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:KONITZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-889-5378
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:RINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17967-0237
Mailing Address - Country:US
Mailing Address - Phone:570-889-5378
Mailing Address - Fax:
Practice Address - Street 1:4200 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:COAL TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:17866-9668
Practice Address - Country:US
Practice Address - Phone:570-644-6109
Practice Address - Fax:570-644-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418250207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty