Healthcare Provider Details

I. General information

NPI: 1487974606
Provider Name (Legal Business Name): YORK COUNTY ANESTHESIA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 07/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 GLENWOOD DR
ROCK HILL SC
29732-2865
US

IV. Provider business mailing address

6094 14TH ST W #133
BRADENTON FL
34207-4104
US

V. Phone/Fax

Practice location:
  • Phone: 803-324-7607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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

VIII. Authorized Official

Name: CUTLER AVERBUCH
Title or Position: PRESIDENT, BOARD OF MANAGERS
Credential:
Phone: 615-843-4033