Healthcare Provider Details

I. General information

NPI: 1497911515
Provider Name (Legal Business Name): ELITE ANESTHESIA, P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 VINEHAVEN DR NE DEPT OF ANESTHESIA
CONCORD NC
28025-2438
US

IV. Provider business mailing address

PO BOX 8846
GREENSBORO NC
27419-0846
US

V. Phone/Fax

Practice location:
  • Phone: 704-783-1840
  • Fax:
Mailing address:
  • Phone: 336-553-1659
  • Fax: 336-553-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL ALLEN MAHLER
Title or Position: PRESIDENT
Credential: CRNA
Phone: 704-701-0851