Healthcare Provider Details

I. General information

NPI: 1164794384
Provider Name (Legal Business Name): NATIONWIDE ANESTHESIA PARTNERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 HEALTHCARE DR
LANCASTER SC
29720-8037
US

IV. Provider business mailing address

PO BOX 992
SANDERSVILLE GA
31082-0992
US

V. Phone/Fax

Practice location:
  • Phone: 803-286-9963
  • Fax:
Mailing address:
  • Phone: 877-364-9803
  • Fax: 800-210-5545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS LYLE JOHNS
Title or Position: PRESIDENT
Credential:
Phone: 800-235-8986