Provider Demographics
NPI:1851486781
Name:CAROLINA ANESTHESIOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:CAROLINA ANESTHESIOLOGY ASSOCIATES PA
Other - Org Name:CRITICAL HEALTH SYSTEMS OF SOUTH CAROLINA, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANHOLTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-566-1639
Mailing Address - Street 1:PO BOX 3387
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21705-3387
Mailing Address - Country:US
Mailing Address - Phone:888-276-1910
Mailing Address - Fax:240-566-1605
Practice Address - Street 1:240 STONERIDGE DR
Practice Address - Street 2:SUITE 304
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-8013
Practice Address - Country:US
Practice Address - Phone:803-708-8126
Practice Address - Fax:803-708-1370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA0365OtherSELECT HEALTH
SCPA0365Medicaid
SC154754700OtherUS DEPARTMENT OF LABOR
SCCM1538OtherRR MEDICARE
SC1358Medicare ID - Type Unspecified