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NPI Code Detail

MEDICARE: LIBERTY ANESTHESIA, PLLC

MEDICARE: LIBERTY ANESTHESIA, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician156084NC

General Provider Information

NPI Number : 1407390792
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIBERTY ANESTHESIA, PLLC
Provider Business Mailing Address
First Line : 695 S BENNETT ST
Second Line :
City : SOUTHERN PINES
State : NC
Zip : 28387-5919
Country : US
Telephone Number : 910-687-6187
Fax Number :
Provider Business Practice Location Address
First Line : 695 S BENNETT ST
Second Line :
City : SOUTHERN PINES
State : NC
Zip : 28387-5919
Country : US
Telephone Number : 910-687-6187
Fax Number :
Authorized Official
Title or Position : CEO
Name : JAMES EDWARD TAYLOR II
Credential : M.D.
Telephone Number : 910-687-6187
Provider Enumeration Date : 12/06/2016
Last Update Date : 03/09/2017

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Directions to “LIBERTY ANESTHESIA, PLLC ” Practice Location

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