Basic Information
| Provider Information | |||||||||
| NPI: | 1487945374 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCKENZIE ANESTHESIA CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1279 OLANTA HWY | ||||||||
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| City: | LAKE CITY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295605351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433193271 | ||||||||
| FaxNumber: | 8436760493 | ||||||||
| Practice Location | |||||||||
| Address1: | 258 N RON MCNAIR BLVD | ||||||||
| Address2: | DEPT OF ANES | ||||||||
| City: | LAKE CITY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295602462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433742036 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2011 | ||||||||
| LastUpdateDate: | 11/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | MCKENZIE | ||||||||
| AuthorizedOfficialFirstName: | SIDNEY | ||||||||
| AuthorizedOfficialMiddleName: | ALLEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8433193271 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 053354 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.