Organization
ANESTHESIA SERVICE INC PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAR L MELDAHL (GROUP ADMINISTRATOR)
(360) 466-2542
Entity
Organization
Contact information
Practice address
1415 E KINCAID ST, MOUNT VERNON, WA 98274-4126
(360) 336-6517
(360) 466-2682
Mailing address
PO BOX 2329, MOUNT VERNON, WA 98273-7329
(360) 336-6517
(360) 466-2682
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0061300
DEPT OF LABOR & INDUSTRIE
WA
01
—
0743
REGENCE BLUE SHIELD
WA
01
—
22989001
GROUP HEALTH
WA
05
—
7844400
—
WA
01
—
CD2096
RAILROAD MEDICARE
WA
01
—
TRICARE
A001
WA
Enumeration date
02/22/2006
Last updated
08/22/2020
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