Provider Demographics
NPI:1881648202
Name:PREMIER ANESTHESIA OF SANFORD A
Entity Type:Organization
Organization Name:PREMIER ANESTHESIA OF SANFORD A
Other - Org Name:PREMIER ANESTHESIA OF SANFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXCUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NORBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUMMEL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:877-742-0399
Mailing Address - Street 1:PO BOX 235022
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-5022
Mailing Address - Country:US
Mailing Address - Phone:334-396-6930
Mailing Address - Fax:334-396-6929
Practice Address - Street 1:1135 CARTHAGE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4162
Practice Address - Country:US
Practice Address - Phone:919-774-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER ANESTHESIA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017T2OtherBCBS-NC GROUP ID #
NC7060782OtherAETNA GROUP ID #
NC=========OtherTRICARE-NORTH GROUP ID#