Healthcare Provider Details

I. General information

NPI: 1801855176
Provider Name (Legal Business Name): PATRICK JON PHLEGAR CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 17 BYPASS WACCAMAW COMMUNITY HOSPITAL
MURRELLS INLET SC
29576
US

IV. Provider business mailing address

914 TAIRILIN DR UNIT D
LAKE CITY SC
29560-4915
US

V. Phone/Fax

Practice location:
  • Phone: 843-652-1000
  • Fax:
Mailing address:
  • Phone: 843-628-0779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN2124
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: