Provider Demographics
NPI:1427015205
Name:CARLEN, JAMES ANTHONY IV (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ANTHONY
Last Name:CARLEN
Suffix:IV
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2637 PINE LAKE DR
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3742
Mailing Address - Country:US
Mailing Address - Phone:803-296-2548
Mailing Address - Fax:803-296-2548
Practice Address - Street 1:2720 SUNSET BLVD
Practice Address - Street 2:LEXINGTON MEDICAL CENTER
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3742
Practice Address - Country:US
Practice Address - Phone:803-791-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1653367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1217Medicaid
SCQ33109Medicare PIN
SCAN1217Medicaid
SCQ33109Medicare UPIN