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General NPI Number Information
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NPI Number | 1538171897
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Entity Type | Organization
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Legal Business Name | SALEM PROFESSIONAL ANESTHESIA SERVICES PC
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | 3812 N ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27455-2596
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Country | US
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Telephone | 336-294-1833
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Fax | 336-998-2889
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Provider Business Mailing Address
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Address Line | 128 PEACHTREE LN SUITE B
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City | ADVANCE
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State | NC
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Zip | 27006-6782
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Country | US
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Telephone | 336-998-3396
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Fax | 336-998-2889
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES PETER NITZ
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Credential | CRNA
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Telephone | 336-998-3396
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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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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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