Basic Information
Provider Information | |||||||||
NPI: | 1821382987 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | UNIFOUR ANESTHESIA ASSOCIATES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 415 N CENTER ST | ||||||||
Address2: | SUITE 201 | ||||||||
City: | HICKORY | ||||||||
State: | NC | ||||||||
PostalCode: | 286015057 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8283278105 | ||||||||
FaxNumber: | 8283274245 | ||||||||
Practice Location | |||||||||
Address1: | 415 N CENTER ST | ||||||||
Address2: | SUITE 201 | ||||||||
City: | HICKORY | ||||||||
State: | NC | ||||||||
PostalCode: | 286015057 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8283278105 | ||||||||
FaxNumber: | 8283274245 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/07/2011 | ||||||||
LastUpdateDate: | 12/11/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | STEVENS | ||||||||
AuthorizedOfficialFirstName: | ROBERT | ||||||||
AuthorizedOfficialMiddleName: | B. | ||||||||
AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 8283278105 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 40254 | NC | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | 40254 | NC | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |   |
ID Information
ID | Type | State | Issuer | Description | 890266A | 05 | NC |   | MEDICAID |