Provider Demographics
NPI:1063650109
Name:WACCAMAW ANESTHESIA CONSULTANTS, PA
Entity Type:Organization
Organization Name:WACCAMAW ANESTHESIA CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:CAMERANSI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:803-765-1838
Mailing Address - Street 1:PO BOX 2013
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-2013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4070 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5033
Practice Address - Country:US
Practice Address - Phone:843-652-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty