1881648202 NPI number — PREMIER ANESTHESIA OF SANFORD A

Table of content: (NPI 1881648202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881648202 NPI number — PREMIER ANESTHESIA OF SANFORD A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER ANESTHESIA OF SANFORD A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PREMIER ANESTHESIA OF SANFORD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881648202
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 235022
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36123-5022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-396-6930
Provider Business Mailing Address Fax Number:
334-396-6929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1135 CARTHAGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27330-4162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-774-2100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUMMEL
Authorized Official First Name:
NORBERT
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
EXCUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
877-742-0399

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 017T2 . This is a "BCBS-NC GROUP ID #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7060782 . This is a "AETNA GROUP ID #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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