Provider Demographics
NPI:1144333659
Name:CANONSBURG ANESTHESIA ASSOC PC
Entity type:Organization
Organization Name:CANONSBURG ANESTHESIA ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-745-6100
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:
Mailing Address - City:CECIL
Mailing Address - State:PA
Mailing Address - Zip Code:15321-0385
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL BLVD
Practice Address - Street 2:CANONSBURG GENERAL HOSIPTAL
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317
Practice Address - Country:US
Practice Address - Phone:724-745-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010709030005Medicaid
PA0010709030005Medicaid