Healthcare Provider Details

I. General information

NPI: 1629096490
Provider Name (Legal Business Name): AIKEN ANESTHESIOLOGY GROUP PA.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 UNIVERSITY PKWY AIKEN REGIONAL MEDICAL CENTER
AIKEN SC
29801-6302
US

IV. Provider business mailing address

PO BOX 7397
AIKEN SC
29804-7397
US

V. Phone/Fax

Practice location:
  • Phone: 336-553-1659
  • Fax: 336-553-3994
Mailing address:
  • Phone: 336-553-1659
  • Fax: 336-553-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BENJAMIN S ULMER JR.
Title or Position: SECRETARY-TREASURER
Credential: MD
Phone: 336-553-1659