Healthcare Provider Details

I. General information

NPI: 1558333773
Provider Name (Legal Business Name): CAROLINA ANESTHESIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 NORTH WASHINGTON ST
SUMTER SC
29150
US

IV. Provider business mailing address

PO BOX 3380
SUMTER SC
29151
US

V. Phone/Fax

Practice location:
  • Phone: 803-436-5582
  • Fax: 803-436-0085
Mailing address:
  • Phone: 803-765-1838
  • Fax: 803-765-1732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIMOTHY WILSON
Title or Position: ANESTHESIOLOGIST
Credential: MD
Phone: 803-765-1838