Provider Demographics
NPI:1467017004
Name:BRANSTITER ANESTHESIA SERVICES, LLC
Entity Type:Organization
Organization Name:BRANSTITER ANESTHESIA SERVICES, LLC
Other - Org Name:BRANSTITER ANESTHESIA SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRANSTITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-614-7304
Mailing Address - Street 1:PO BOX 1467
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-1467
Mailing Address - Country:US
Mailing Address - Phone:866-283-6375
Mailing Address - Fax:803-765-1732
Practice Address - Street 1:1844 WALLACE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4822
Practice Address - Country:US
Practice Address - Phone:843-614-7304
Practice Address - Fax:803-765-1732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist AssistantGroup - Multi-Specialty