Healthcare Provider Details

I. General information

NPI: 1043557432
Provider Name (Legal Business Name): PPC ANESTHESIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W 24TH ST SUITE #303
ERIE PA
16502-2665
US

IV. Provider business mailing address

311 W 24TH ST SUITE #303
ERIE PA
16502-2665
US

V. Phone/Fax

Practice location:
  • Phone: 814-454-1530
  • Fax: 814-452-7792
Mailing address:
  • Phone: 814-454-1530
  • Fax: 814-452-7792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD420312
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN511115L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN511115L
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD420312
License Number StatePA

VIII. Authorized Official

Name: DR. PAUL P CARNES
Title or Position: PRESIDENT
Credential: MD
Phone: 814-454-1530