MEDICARE: CARDIOVASCULAR ANSTHESIA, 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	207LP2900X	Pain Medicine (Anesthesiology) Physician
2	207L00000X	Anesthesiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497726160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR ANSTHESIA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 25448
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29224-5448
Country	:	US
Telephone Number	:	803-765-1838
Fax Number	:	803-765-1732

Provider Business Practice Location Address
First Line	:	2435 FOREST DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2026
Country	:	US
Telephone Number	:	803-765-1838
Fax Number	:	803-765-1732

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN F WILLIAMS
Credential	:
Telephone Number	:	803-256-0447

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	10/04/2007

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