1417900986 NPI number — SYLVA ANESTHESIOLOGY, PA

Table of content: DR. SHELDON ARNOLD OLESEN D.D.S. (NPI 1356477913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417900986 NPI number — SYLVA ANESTHESIOLOGY, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYLVA ANESTHESIOLOGY, 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:
1417900986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2008
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:
334-386-2054
Provider Business Mailing Address Fax Number:
334-244-1830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
59 HOSPITAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLVA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28779-2732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-386-2054
Provider Business Practice Location Address Fax Number:
334-244-1830
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARLETON
Authorized Official First Name:
TERRIE
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
ACCOUNT MANAGER
Authorized Official Telephone Number:
334-386-2054

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 89011UV , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: CM3416 . This is a "RAILROAD MEDICARE PROV #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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