Provider Demographics
NPI:1023779691
Name:PROVIDENCE ANESTHESIOLOGY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:PROVIDENCE ANESTHESIOLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PROVIDER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:HELMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-749-5800
Mailing Address - Street 1:3735 GLENLAKE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-6866
Mailing Address - Country:US
Mailing Address - Phone:704-749-5800
Mailing Address - Fax:704-626-3272
Practice Address - Street 1:3735 GLENLAKE DR STE 250
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-6866
Practice Address - Country:US
Practice Address - Phone:704-749-5800
Practice Address - Fax:704-626-3272
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDENCE ANESTHESIOLOGY ASSOCIATES, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty