Basic Information
| Provider Information | |||||||||
| NPI: | 1427008440 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENSBORO ANESTHESIA PHYSICIANS,PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3625 N ELM ST | ||||||||
| Address2: | SUITE 110A | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274552604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362824840 | ||||||||
| FaxNumber: | 3362824660 | ||||||||
| Practice Location | |||||||||
| Address1: | 3625 N ELM ST | ||||||||
| Address2: | SUITE 110A | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274552604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362824840 | ||||||||
| FaxNumber: | 3362824660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 12/01/2009 | ||||||||
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| AuthorizedOfficialLastName: | BREWER | ||||||||
| AuthorizedOfficialFirstName: | JUDY | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3362824840 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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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 | 2000971 | 01 | NC | UHC | OTHER | 790265E | 05 | NC | MEDICAID | 0168T | 01 | NC | BCBS NC | OTHER |