Provider Demographics
NPI:1811409568
Name:ANESTHESIOLOGY CONSULTANTS OF NORTH CAROLINA PLLC
Entity Type:Organization
Organization Name:ANESTHESIOLOGY CONSULTANTS OF NORTH CAROLINA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSTERLYTZKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-808-5135
Mailing Address - Street 1:PO BOX 740931
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0931
Mailing Address - Country:US
Mailing Address - Phone:888-276-1910
Mailing Address - Fax:770-701-6718
Practice Address - Street 1:1200 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1004
Practice Address - Country:US
Practice Address - Phone:336-832-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty