Healthcare Provider Details

I. General information

NPI: 1679840383
Provider Name (Legal Business Name): VIGILANCE ANAESTHESIA GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 CLAIRTON RD
WEST MIFFLIN PA
15122-2475
US

IV. Provider business mailing address

255 W MICHIGAN AVE P O BOX 1123
JACKSON MI
49201-2218
US

V. Phone/Fax

Practice location:
  • Phone: 412-714-8346
  • Fax:
Mailing address:
  • Phone: 800-242-1131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TERRY E BUCKWALTER JR.
Title or Position: AUTHORIZED REPRESENTATIVE
Credential: DO
Phone: 724-946-8251