1790185387 NPI number — GLYNN ANESTHESIA ASSOCIATES, INC.

Table of content: (NPI 1790185387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790185387 NPI number — GLYNN ANESTHESIA ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLYNN ANESTHESIA ASSOCIATES, INC.
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:
1790185387
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 235019
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:
36123-5019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-279-1450
Provider Business Mailing Address Fax Number:
334-395-4110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3217 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRUNSWICK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31520-3759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-267-0058
Provider Business Practice Location Address Fax Number:
334-395-4110
Provider Enumeration Date:
09/02/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
LISA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VP, HR
Authorized Official Telephone Number:
334-279-1450

Provider Taxonomy Codes

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

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





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