Basic Information
| Provider Information | |||||||||
| NPI: | 1033412267 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN ANESTHESIOLOGY OF NORTH CAROLINA, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1305 WALT WHITMAN RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | MELVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117474300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162084250 | ||||||||
| FaxNumber: | 4482062955 | ||||||||
| Practice Location | |||||||||
| Address1: | 2520 INDEPENDENCE BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104421100 | ||||||||
| FaxNumber: | 9104421199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2010 | ||||||||
| LastUpdateDate: | 03/03/2022 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | JOSHUA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8002433839 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 024AA | 01 | NC | BCBS | OTHER | 5917193 (MD) | 05 | NC | MEDICAID | 8053959 (CRNA) | 05 | NC | MEDICAID | CB1276 | 01 | NC | RAILRAOD-MEDICARE | OTHER |