Provider Demographics
NPI:1992776553
Name:PROFESSIONAL ANESTHESIA SERVICES OF EASTERN PENNSYLVANIA, P.C.
Entity type:Organization
Organization Name:PROFESSIONAL ANESTHESIA SERVICES OF EASTERN PENNSYLVANIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AMICO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:610-428-1544
Mailing Address - Street 1:7918 MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FOGELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18051-1744
Mailing Address - Country:US
Mailing Address - Phone:610-428-1544
Mailing Address - Fax:610-395-9336
Practice Address - Street 1:7918 MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:FOGELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18051-1744
Practice Address - Country:US
Practice Address - Phone:610-428-1544
Practice Address - Fax:610-395-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
001370187OtherHIGHMARK BS
PACJ8874OtherTRAVELERS MEDICARE
PACJ8874OtherTRAVELERS MEDICARE