Provider Demographics
NPI:1538157342
Name:ALLENTOWN ANESTHESIA ASSOCIATES, INC.
Entity type:Organization
Organization Name:ALLENTOWN ANESTHESIA ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-866-9583
Mailing Address - Street 1:4905 W. TILGHMAN ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104
Mailing Address - Country:US
Mailing Address - Phone:484-866-9583
Mailing Address - Fax:610-366-1147
Practice Address - Street 1:4905 W. TILGHMAN ST
Practice Address - Street 2:SUITE 250
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104
Practice Address - Country:US
Practice Address - Phone:484-866-9583
Practice Address - Fax:610-366-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA363A00000X, 363L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP003209OtherTRICARE
PA46933OtherKEYSTONE MERCY
PA7066511OtherGATEWAY
NJ3527409Medicaid
PAAL6651OtherKEYSTONE CENTRAL
PA0007166800008Medicaid
PA0040553000OtherINDEP. BLUE CROSS
PA066511OtherHIGHMARK
PA0040553000OtherINDEP. BLUE CROSS
PA0007166800008Medicaid
PA066511EU8Medicare PIN