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General NPI Number Information
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NPI Number | 1144557232
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Entity Type | Organization
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Legal Business Name | ANESTHESIA WORKS LLC
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Dates
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Enumeration Date | 11/10/2009
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 1735 TAYLOR ST
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City | COLUMBIA
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State | SC
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Zip | 29201-3452
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Country | US
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Telephone | 803-254-3452
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Fax |
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Provider Business Mailing Address
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Address Line | 148 WELCHMAN AVE
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City | GOOSE CREEK
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State | SC
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Zip | 29445-7152
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Country | US
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Telephone | 843-327-6616
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN WALTHALL
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Credential | CRNA
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Telephone | 843-327-6616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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