Provider Demographics
NPI:1073632600
Name:PREMIER ANESTHESIA ASSOCIATES
Entity Type:Organization
Organization Name:PREMIER ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-838-1585
Mailing Address - Street 1:PO BOX 724928
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31139-9028
Mailing Address - Country:US
Mailing Address - Phone:678-838-1585
Mailing Address - Fax:
Practice Address - Street 1:330 ALCOVY ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2140
Practice Address - Country:US
Practice Address - Phone:678-838-1585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP6349OtherMEDICARE GROUP NUMBER
GA05BDJZKMedicare PIN
GA43BBCXJMedicare PIN
05BDJZHMedicare PIN
05BDLBJMedicare PIN
GRP6349OtherMEDICARE GROUP NUMBER