Provider Demographics
NPI:1821866476
Name:SCG ANESTHESIA, PLLC
Entity Type:Organization
Organization Name:SCG ANESTHESIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:STACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-720-9111
Mailing Address - Street 1:PO BOX 713477
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-4377
Mailing Address - Country:US
Mailing Address - Phone:810-285-9901
Mailing Address - Fax:810-285-9974
Practice Address - Street 1:5302 GATEWAY CTR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3930
Practice Address - Country:US
Practice Address - Phone:810-285-9901
Practice Address - Fax:810-285-9974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty