Provider Demographics
NPI:1528025145
Name:NASH ANESTHESIA ASSOCIATES, PA
Entity Type:Organization
Organization Name:NASH ANESTHESIA ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-443-2125
Mailing Address - Street 1:3709 WESTRIDGE CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3335
Mailing Address - Country:US
Mailing Address - Phone:252-443-2125
Mailing Address - Fax:252-937-2508
Practice Address - Street 1:3709 WESTRIDGE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3335
Practice Address - Country:US
Practice Address - Phone:252-443-2125
Practice Address - Fax:252-937-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39647207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02273OtherNCBCBS
NC8902273Medicaid
NC8902273Medicaid