Healthcare Provider Details

I. General information

NPI: 1679972632
Provider Name (Legal Business Name): ANESTHESIA AT SYNERGY SPINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 E BYPASS 123
SENECA SC
29678
US

IV. Provider business mailing address

PO BOX 16068
HIGH POINT NC
27261-6068
US

V. Phone/Fax

Practice location:
  • Phone: 864-882-8850
  • Fax: 864-882-3420
Mailing address:
  • Phone: 888-447-7220
  • Fax: 336-884-1643

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: MARION R MCMILLAN III
Title or Position: MEDICAL DIRECTOR / OWNER
Credential: MD
Phone: 864-882-8850