Provider Demographics
NPI:1558435388
Name:MARIA PARHAM ANESTHESIA AND PHYSIATRY CENTER, INC
Entity Type:Organization
Organization Name:MARIA PARHAM ANESTHESIA AND PHYSIATRY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-438-4143
Mailing Address - Street 1:568 RUIN CREEK RD
Mailing Address - Street 2:SUITE 128
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2880
Mailing Address - Country:US
Mailing Address - Phone:252-436-1380
Mailing Address - Fax:252-436-1581
Practice Address - Street 1:568 RUIN CREEK RD
Practice Address - Street 2:SUITE 128
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2880
Practice Address - Country:US
Practice Address - Phone:252-436-1380
Practice Address - Fax:252-436-1581
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIA PARHAM MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-20
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014EPMedicaid
NC2352680Medicare PIN