Provider Demographics
NPI:1962539643
Name:ANESTHESIA ASSOC. OF SCHUYLKILL COUNTY
Entity type:Organization
Organization Name:ANESTHESIA ASSOC. OF SCHUYLKILL COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MGR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAWK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-421-8196
Mailing Address - Street 1:401 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2404
Mailing Address - Country:US
Mailing Address - Phone:570-421-8196
Mailing Address - Fax:570-476-6213
Practice Address - Street 1:700 E NORWEGIAN ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2710
Practice Address - Country:US
Practice Address - Phone:570-621-4000
Practice Address - Fax:570-476-6213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000101335331Medicaid
PA088073Medicare PIN