Organization
INNOVUS ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T MITCHELL (MANAGING MBR)
(843) 651-2624
Entity
Organization
Contact information
Practice address
9701 SW BARNES RD STE 300, PORTLAND, OR 97225-6689
(843) 651-2624
(843) 491-4023
Mailing address
PO BOX 4860, MURRELLS INLET, SC 29576-2698
(843) 651-2624
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
04/15/2021
Last updated
04/15/2021
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