Healthcare Provider Details

I. General information

NPI: 1902316557
Provider Name (Legal Business Name): ANESTHESIA AFICIANADOS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 CLEMSON BLVD STE 200
SENECA SC
29678-4545
US

IV. Provider business mailing address

PO BOX 2585
COLUMBUS GA
31902-2585
US

V. Phone/Fax

Practice location:
  • Phone: 864-482-5100
  • Fax: 864-482-9100
Mailing address:
  • Phone: 706-660-8505
  • Fax: 706-660-1454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number13790
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: HENRY H SALZARULO
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 864-482-5100