Healthcare Provider Details

I. General information

NPI: 1285897074
Provider Name (Legal Business Name): YPS ANESTHESIA SC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 NORTH ST
BAMBERG SC
29003-1330
US

IV. Provider business mailing address

PO BOX 16068
HIGH POINT NC
27261-6068
US

V. Phone/Fax

Practice location:
  • Phone: 336-882-4615
  • Fax:
Mailing address:
  • Phone: 336-882-4615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. TRACY PAUL YOUNG
Title or Position: OWNER
Credential: CRNA
Phone: 337-519-6574