Basic Information
| Provider Information | |||||||||
| NPI: | 1992943484 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOBILE ANESTHESIA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 LITTLE PALM LOOP | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294646622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435537070 | ||||||||
| FaxNumber: | 8435532223 | ||||||||
| Practice Location | |||||||||
| Address1: | 9263 MEDICAL PLAZA DR | ||||||||
| Address2: | STE E | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294067112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435537070 | ||||||||
| FaxNumber: | 8435532223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2009 | ||||||||
| LastUpdateDate: | 08/02/2012 | ||||||||
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| AuthorizedOfficialLastName: | INMAN | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8435537070 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 17252 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | DP2217 | 01 | SC | RAILROAD MEDICARE | OTHER | GP5188 | 05 | SC | MEDICAID |