Provider Demographics
NPI:1053523886
Name:ANESTHESIA PUGET SOUND PLLC
Entity type:Organization
Organization Name:ANESTHESIA PUGET SOUND PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:STILLMAN
Authorized Official - Last Name:ELSEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:425-345-1947
Mailing Address - Street 1:PMB 954
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258
Mailing Address - Country:US
Mailing Address - Phone:425-345-1947
Mailing Address - Fax:
Practice Address - Street 1:1418 E LAKESHORE DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258
Practice Address - Country:US
Practice Address - Phone:425-345-1947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000995367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA430043140OtherMEDICARE RAILROAD
WAEL3744OtherREGENCE BLUE SHIELD
VA9606195Medicaid
WAR30290Medicare UPIN
WAGAB03883Medicare ID - Type UnspecifiedMEDICARE