Provider Demographics
NPI:1225166804
Name:ANSON PEDIATRICS INC
Entity Type:Organization
Organization Name:ANSON PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:POWELL
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-994-2300
Mailing Address - Street 1:904 MORVEN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-2834
Mailing Address - Country:US
Mailing Address - Phone:704-994-2300
Mailing Address - Fax:704-994-2373
Practice Address - Street 1:904 MORVEN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2834
Practice Address - Country:US
Practice Address - Phone:704-994-2300
Practice Address - Fax:704-994-2373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8930608Medicaid
NC8930608Medicaid