Provider Demographics
NPI:1962459115
Name:MOSAIC ANESTHESIA & PERIOPERATIVE SERVICES, PA
Entity Type:Organization
Organization Name:MOSAIC ANESTHESIA & PERIOPERATIVE SERVICES, PA
Other - Org Name:NEW BERN ANESTHESIA ASSOCIATES, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-633-6117
Mailing Address - Street 1:2719 NEUSE BLVD
Mailing Address - Street 2:B & C
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2840
Mailing Address - Country:US
Mailing Address - Phone:252-633-6117
Mailing Address - Fax:252-633-2644
Practice Address - Street 1:2719 NEUSE BLVD
Practice Address - Street 2:B & C
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2840
Practice Address - Country:US
Practice Address - Phone:252-633-6117
Practice Address - Fax:252-633-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902319Medicaid
NC8902319Medicaid