Organization
KOM ANESTHESIA SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN E SIAPCO CRNA (PROVIDER/OWNER)
(253) 797-4910
Entity
Organization
Contact information
Practice address
2100 LITTLE MOUNTAIN LN, MOUNT VERNON, WA 98274-8752
(360) 416-6735
Mailing address
PO BOX 97115, LAKEWOOD, WA 98497-0115
(253) 588-7911
(253) 984-6774
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
AP30006883
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP30006883
PROFESSIONAL LICENSE
WA
Enumeration date
11/16/2010
Last updated
11/16/2010
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