Provider Demographics
NPI:1417030206
Name:MARIA PARHAM ANESTHESIA AND PHYSIATRY CENTER INC
Entity Type:Organization
Organization Name:MARIA PARHAM ANESTHESIA AND PHYSIATRY CENTER INC
Other - Org Name:DBA NORTHERN CAROLINA SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF PHYSICIAN PRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:252-436-1624
Mailing Address - Street 1:120 CHARLES ROLLINS RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2882
Mailing Address - Country:US
Mailing Address - Phone:252-436-0430
Mailing Address - Fax:252-492-5707
Practice Address - Street 1:120 CHARLES ROLLINS RD
Practice Address - Street 2:SUITE 206
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2882
Practice Address - Country:US
Practice Address - Phone:252-436-0430
Practice Address - Fax:252-492-5707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2352680CMedicare ID - Type Unspecified