Basic Information
| Provider Information | |||||||||
| NPI: | 1891934253 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH AREA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 SAINT JAMES AVE | ||||||||
| Address2: | |||||||||
| City: | GOOSE CREEK | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294452997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437976800 | ||||||||
| FaxNumber: | 8437976825 | ||||||||
| Practice Location | |||||||||
| Address1: | 2671 ELMS PLANTATION BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294069165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437976800 | ||||||||
| FaxNumber: | 8437976825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2009 | ||||||||
| LastUpdateDate: | 02/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | ADELMAN | ||||||||
| AuthorizedOfficialFirstName: | JUDD | ||||||||
| AuthorizedOfficialMiddleName: | BRONE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8437976800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.