Provider Demographics
NPI:1174513824
Name:ANESTHESIOLOGY SERVICES OF ANDERSON, PA
Entity type:Organization
Organization Name:ANESTHESIOLOGY SERVICES OF ANDERSON, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-431-1958
Mailing Address - Street 1:PO BOX 1657
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-1657
Mailing Address - Country:US
Mailing Address - Phone:864-431-1958
Mailing Address - Fax:
Practice Address - Street 1:800 N FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5708
Practice Address - Country:US
Practice Address - Phone:864-431-1958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13681207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1396Medicaid
SC080959Medicaid
SC144560Medicaid
SC077446Medicaid
SC057002Medicaid
SC269701Medicaid
SCTL4288Medicaid
SC077446Medicaid
SCB92508Medicare UPIN
SCG89433Medicare UPIN
SC077446Medicaid
SCB91820Medicare UPIN
SC269701Medicaid
SCG56355Medicare UPIN
SC080959Medicaid
SCD47487Medicare UPIN
SCI08420Medicare UPIN
SCF32384Medicare UPIN
SCD99421Medicare UPIN
SCGP1396Medicaid