=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386753457
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAKE NORMAN ANESTHESIA ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 09/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 114 COMMERCE CENTER LOOP STE B
-----------------------------------------------------
City | MOORESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28117-8385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-662-0877
-----------------------------------------------------
Fax | 704-662-0875
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 114 COMMERCE CENTER LOOP STE B
-----------------------------------------------------
City | MOORESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28117-8385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-662-0877
-----------------------------------------------------
Fax | 704-662-0875
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | AMY M HOWARD
-----------------------------------------------------
Credential | CPC, CPB
-----------------------------------------------------
Telephone | 704-662-0877
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------