Basic Information
| Provider Information | |||||||||
| NPI: | 1851486781 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINA ANESTHESIOLOGY ASSOCIATES PA | ||||||||
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| OtherOrganizationName: | CRITICAL HEALTH SYSTEMS OF SOUTH CAROLINA, LLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3387 | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217053387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882761910 | ||||||||
| FaxNumber: | 2405661605 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 STONERIDGE DR | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292108013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037088126 | ||||||||
| FaxNumber: | 8037081370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 12/18/2014 | ||||||||
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| AuthorizedOfficialLastName: | SHANHOLTZER | ||||||||
| AuthorizedOfficialFirstName: | BRITTNEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 2405661639 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LC0200X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine | 207LP2900X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | PA0365 | 01 | SC | SELECT HEALTH | OTHER | PA0365 | 05 | SC | MEDICAID | 154754700 | 01 | SC | US DEPARTMENT OF LABOR | OTHER | CM1538 | 01 | SC | RR MEDICARE | OTHER |