Provider Demographics
NPI:1013940253
Name:PREMIER ANESTHESIA OF RICHLAND A DIVISION OF PREMIER ANESTHESIA, LLC
Entity Type:Organization
Organization Name:PREMIER ANESTHESIA OF RICHLAND A DIVISION OF PREMIER ANESTHESIA, LLC
Other - Org Name:PREMIER ANESTHESIA OF RICHLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXCUTIVE VICE PRESIDENT
Authorized Official - Prefix:
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:770-643-5501
Mailing Address - Street 1:2655 NORTHWINDS PKWY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2280
Mailing Address - Country:US
Mailing Address - Phone:770-643-5501
Mailing Address - Fax:404-941-1304
Practice Address - Street 1:888 SWIFT BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3514
Practice Address - Country:US
Practice Address - Phone:770-643-5501
Practice Address - Fax:404-941-1304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist AssistantGroup - Single Specialty