MEDICARE: ALL-AMERICAN ANESTHESIA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0800X	Endoscopy Clinic/Center	47590	NC

General Provider Information

NPI Number	:	1407200744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL-AMERICAN ANESTHESIA LLC

Provider Business Mailing Address
First Line	:	3202 BOONE TRL
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-2134
Country	:	US
Telephone Number	:	855-888-3749
Fax Number	:

Provider Business Practice Location Address
First Line	:	3202 BOONE TRL
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-2134
Country	:	US
Telephone Number	:	855-888-3749
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALER
Name	:	NIKI JOHNSON
Credential	:
Telephone Number	:	855-888-3749

Provider Enumeration Date	:	04/22/2016
Last Update Date	:	04/22/2016

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