Healthcare Provider Details

I. General information

NPI: 1487832754
Provider Name (Legal Business Name): MARIA PARHAM ANESTHESIA AND PHYSIATRY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 RUIN CREEK RD SUITE 128
HENDERSON NC
27536-2880
US

IV. Provider business mailing address

568 RUIN CREEK RD SUITE 128
HENDERSON NC
27536-2880
US

V. Phone/Fax

Practice location:
  • Phone: 252-436-1380
  • Fax: 252-436-1555
Mailing address:
  • Phone: 252-436-1380
  • Fax: 252-436-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JIM CHATMAN
Title or Position: CFO/VICE PRESIDENT-FINANCE
Credential:
Phone: 252-436-1101