Provider Demographics
NPI:1417900986
Name:SYLVA ANESTHESIOLOGY, PA
Entity Type:Organization
Organization Name:SYLVA ANESTHESIOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-386-2054
Mailing Address - Street 1:PO BOX 235022
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-5022
Mailing Address - Country:US
Mailing Address - Phone:334-386-2054
Mailing Address - Fax:334-244-1830
Practice Address - Street 1:59 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-2732
Practice Address - Country:US
Practice Address - Phone:334-386-2054
Practice Address - Fax:334-244-1830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89011UVMedicaid
NCCM3416OtherRAILROAD MEDICARE PROV #
NCCM3416OtherRAILROAD MEDICARE PROV #