Healthcare Provider Details

I. General information

NPI: 1467017004
Provider Name (Legal Business Name): BRANSTITER ANESTHESIA SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 WALLACE SCHOOL RD
CHARLESTON SC
29407-4822
US

IV. Provider business mailing address

PO BOX 1467
COLUMBIA SC
29202-1467
US

V. Phone/Fax

Practice location:
  • Phone: 843-614-7304
  • Fax: 803-765-1732
Mailing address:
  • Phone: 866-283-6375
  • Fax: 803-765-1732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name: ALY D BRANSTITER
Title or Position: PRESIDENT
Credential:
Phone: 843-614-7304