Provider Demographics
NPI:1609833474
Name:ANESTHESIA CARE SERVICES, PA
Entity type:Organization
Organization Name:ANESTHESIA CARE SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOTER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:336-821-4171
Mailing Address - Street 1:PO BOX 16068
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27261-6068
Mailing Address - Country:US
Mailing Address - Phone:888-447-7220
Mailing Address - Fax:336-884-1643
Practice Address - Street 1:1834 GRAVES MILL ROAD
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551
Practice Address - Country:US
Practice Address - Phone:888-447-7220
Practice Address - Fax:336-884-1643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08691Medicare PIN
NC2332174AMedicare PIN