Provider Demographics
NPI:1487256657
Name:ACANESTHESIA
Entity type:Organization
Organization Name:ACANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:H
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:919-225-5874
Mailing Address - Street 1:PO BOX 660257
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35266-0257
Mailing Address - Country:US
Mailing Address - Phone:803-779-3263
Mailing Address - Fax:
Practice Address - Street 1:2611 FOREST DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2371
Practice Address - Country:US
Practice Address - Phone:919-225-5874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty