1932189081 NPI number — ANESTHESIOLOGY OF GREENWOOD PA

Table of content: KATIE DANIELLE RYAN RBT (NPI 1437797461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932189081 NPI number — ANESTHESIOLOGY OF GREENWOOD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANESTHESIOLOGY OF GREENWOOD PA
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:
Provider Other Organization Name Type Code:
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:
1932189081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 742324
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-2103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-860-2701
Provider Business Mailing Address Fax Number:
706-860-6484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1325 SPRING ST
Provider Second Line Business Practice Location Address:
ANESTHESIA DEPT
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29646-3860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-227-4111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARWELL
Authorized Official First Name:
DEREK
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
864-227-8242

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP0733 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".