Provider Demographics
NPI:1407200744
Name:ALL-AMERICAN ANESTHESIA LLC
Entity Type:Organization
Organization Name:ALL-AMERICAN ANESTHESIA LLC
Other - Org Name:EPIX - ALL-AMERICAN ANESTHESIA LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALER
Authorized Official - Prefix:
Authorized Official - First Name:NIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-888-3749
Mailing Address - Street 1:3202 BOONE TRL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-2134
Mailing Address - Country:US
Mailing Address - Phone:855-888-3749
Mailing Address - Fax:
Practice Address - Street 1:3202 BOONE TRL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-2134
Practice Address - Country:US
Practice Address - Phone:855-888-3749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPIX - ALL-AMERICAN ANESTHESIA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC47590261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2615552BMedicare PIN