Provider Demographics
NPI:1275561920
Name:ALBEMARLE ANESTHESIOLOGY, PA
Entity Type:Organization
Organization Name:ALBEMARLE ANESTHESIOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHNSACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-984-4186
Mailing Address - Street 1:PO BOX 2119
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28002-2119
Mailing Address - Country:US
Mailing Address - Phone:704-984-4186
Mailing Address - Fax:704-983-6624
Practice Address - Street 1:301 YADKIN ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3441
Practice Address - Country:US
Practice Address - Phone:704-984-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC013T4OtherBC GROUP
NC89013T4Medicaid
SCQPB960OtherSC MEDICAID
NC2330158Medicare ID - Type UnspecifiedGROUP NUMBER