Basic Information
| Provider Information | |||||||||
| NPI: | 1679972632 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIA AT SYNERGY SPINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16068 | ||||||||
| Address2: | |||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272616068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884477220 | ||||||||
| FaxNumber: | 3368841643 | ||||||||
| Practice Location | |||||||||
| Address1: | 457 E BYPASS 123 | ||||||||
| Address2: | |||||||||
| City: | SENECA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648828850 | ||||||||
| FaxNumber: | 8648823420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2014 | ||||||||
| LastUpdateDate: | 08/15/2014 | ||||||||
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| AuthorizedOfficialLastName: | MCMILLAN | ||||||||
| AuthorizedOfficialFirstName: | MARION | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR / OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8648828850 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SYNERGY SPINE CENTER, PA | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.