Provider Demographics
NPI:1992993174
Name:D H ANESTHESIA SERVICES
Entity type:Organization
Organization Name:D H ANESTHESIA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOEKSEMA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:269-945-2176
Mailing Address - Street 1:1247 OLD LAKE CT SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-4352
Mailing Address - Country:US
Mailing Address - Phone:269-945-2176
Mailing Address - Fax:269-945-0885
Practice Address - Street 1:1247 OLD LAKE CT SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-4352
Practice Address - Country:US
Practice Address - Phone:269-945-2176
Practice Address - Fax:269-945-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704113698367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4308752770OtherBLUE CROSS BLUE SHIELD
MI502626Medicare UPIN
MI0N88310Medicare PIN