Healthcare Provider Details

I. General information

NPI: 1215907852
Provider Name (Legal Business Name): UNIFOUR ANESTHESIA ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N CENTER ST STE 201
HICKORY NC
28601-5036
US

IV. Provider business mailing address

415 N CENTER ST STE 201
HICKORY NC
28601-5036
US

V. Phone/Fax

Practice location:
  • Phone: 828-327-8105
  • Fax: 828-327-4245
Mailing address:
  • Phone: 828-327-8105
  • Fax: 828-327-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number40254
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number40254
License Number StateNC

VIII. Authorized Official

Name: GERRIE L REEVES
Title or Position: PRACTICE MANAGER
Credential:
Phone: 828-327-8105