Provider Demographics
NPI:1952374217
Name:LUMBERTON ANESTHESIA CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:LUMBERTON ANESTHESIA CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-738-8154
Mailing Address - Street 1:2905 N ELM ST
Mailing Address - Street 2:P O BOX 2370
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2982
Mailing Address - Country:US
Mailing Address - Phone:910-738-8154
Mailing Address - Fax:910-671-8818
Practice Address - Street 1:2905 N ELM ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2982
Practice Address - Country:US
Practice Address - Phone:910-738-8154
Practice Address - Fax:910-671-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0176GOtherBLUE CROSS BLUE SHIELD
NC890176GMedicaid
NCCI4206OtherMEDICARE ID - RAILROAD
NC0176GOtherBLUE CROSS BLUE SHIELD