Provider Demographics
NPI:1053474122
Name:LAWRENCE COUNTY ANESTHESIA ASSOC PC
Entity Type:Organization
Organization Name:LAWRENCE COUNTY ANESTHESIA ASSOC PC
Other - Org Name:THE NOUR GROUP FOR PAIN MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:NOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-431-0609
Mailing Address - Street 1:171 OMNI ST
Mailing Address - Street 2:
Mailing Address - City:FOMBELL
Mailing Address - State:PA
Mailing Address - Zip Code:16123-2109
Mailing Address - Country:US
Mailing Address - Phone:724-752-5230
Mailing Address - Fax:724-431-0611
Practice Address - Street 1:103 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1785
Practice Address - Country:US
Practice Address - Phone:724-431-0609
Practice Address - Fax:724-431-0611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051358L174400000X
PAMD051352L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA354726OtherBLUE SHIELD
PA0014803580005Medicaid
PACN8900OtherRAILROAD MEDICARE
PA000000079135OtherUNISON
PA1047501OtherAETNA HMO MEDICARE
PA1503378OtherGATEWAY
PA82851OtherHEALTH ASSURANCE
PA251748OtherUPMC
PA251748OtherUPMC
PA000000079135OtherUNISON
PA1503378OtherGATEWAY