Provider Demographics
NPI:1679840383
Name:VIGILANCE ANAESTHESIA GROUP
Entity Type:Organization
Organization Name:VIGILANCE ANAESTHESIA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BUCKWALTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:724-946-8251
Mailing Address - Street 1:255 W MICHIGAN AVE
Mailing Address - Street 2:P O BOX 1123
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2218
Mailing Address - Country:US
Mailing Address - Phone:800-242-1131
Mailing Address - Fax:
Practice Address - Street 1:6161 CLAIRTON RD
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-2475
Practice Address - Country:US
Practice Address - Phone:412-714-8346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty