Healthcare Provider Details

I. General information

NPI: 1881648202
Provider Name (Legal Business Name): PREMIER ANESTHESIA OF SANFORD A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 CARTHAGE ST
SANFORD NC
27330-4162
US

IV. Provider business mailing address

PO BOX 235022
MONTGOMERY AL
36123-5022
US

V. Phone/Fax

Practice location:
  • Phone: 919-774-2100
  • Fax:
Mailing address:
  • Phone: 334-396-6930
  • Fax: 334-396-6929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. NORBERT D. HUMMEL III
Title or Position: EXCUTIVE VICE PRESIDENT
Credential:
Phone: 877-742-0399