Healthcare Provider Details

I. General information

NPI: 1982908737
Provider Name (Legal Business Name): PREMIER ANESTHESIA OF INDIANA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 02/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E MAIN ST
DANVILLE IN
46122-1948
US

IV. Provider business mailing address

2655 NORTHWINDS PKWY
ALPHARETTA GA
30009-2280
US

V. Phone/Fax

Practice location:
  • Phone: 404-941-1210
  • Fax: 404-941-1304
Mailing address:
  • Phone: 404-941-1210
  • Fax: 404-941-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PHILIP SOCOLOFF
Title or Position: VP OF OPERATIONS
Credential:
Phone: 404-941-1210