Healthcare Provider Details

I. General information

NPI: 1124503487
Provider Name (Legal Business Name): UNIVERSAL ANESTHESIA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 BLARNEY DR
COLUMBIA SC
29223-6244
US

IV. Provider business mailing address

113 BLARNEY DR
COLUMBIA SC
29223-6244
US

V. Phone/Fax

Practice location:
  • Phone: 803-788-2225
  • Fax: 803-788-2120
Mailing address:
  • Phone: 803-788-2225
  • Fax: 803-788-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: USAMA A GABR
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 513-309-8523