Provider Demographics
NPI:1043557432
Name:PPC ANESTHESIA, INC.
Entity Type:Organization
Organization Name:PPC ANESTHESIA, INC.
Other - Org Name:PAIN MANAGEMENT ASSOCIATES OF NWPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-454-1530
Mailing Address - Street 1:311 W 24TH ST
Mailing Address - Street 2:SUITE #303
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2665
Mailing Address - Country:US
Mailing Address - Phone:814-454-1530
Mailing Address - Fax:814-452-7792
Practice Address - Street 1:311 W 24TH ST
Practice Address - Street 2:SUITE #303
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2665
Practice Address - Country:US
Practice Address - Phone:814-454-1530
Practice Address - Fax:814-452-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420312207L00000X, 207LP2900X
PARN511115L363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty