Provider Demographics
NPI:1962446781
Name:CAPITOL ANESTHESIA SERVICES P.A.
Entity type:Organization
Organization Name:CAPITOL ANESTHESIA SERVICES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:651-842-3344
Mailing Address - Street 1:2854 HIGHWAY 55
Mailing Address - Street 2:SUITE 130
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1405
Mailing Address - Country:US
Mailing Address - Phone:651-842-3344
Mailing Address - Fax:651-842-3391
Practice Address - Street 1:2854 HIGHWAY 55
Practice Address - Street 2:SUITE 130
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1405
Practice Address - Country:US
Practice Address - Phone:651-842-3344
Practice Address - Fax:651-842-3391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C03360Medicare PIN