Provider Demographics
NPI:1265188601
Name:CHARTER ANESTHESIA GROUP PLC
Entity type:Organization
Organization Name:CHARTER ANESTHESIA GROUP PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-210-5740
Mailing Address - Street 1:1345 WILLOWDALE CT STE A
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4737
Mailing Address - Country:US
Mailing Address - Phone:810-210-5740
Mailing Address - Fax:810-720-4661
Practice Address - Street 1:1144 CHARTER DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3586
Practice Address - Country:US
Practice Address - Phone:810-720-5130
Practice Address - Fax:810-720-4661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty