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Organization
CHARLESTON ANESTHESIA GROUP LLC
Active
Organization
CHARLESTON ANESTHESIA GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN DALE HILLIARD (CFO)
(336) 884-1830
Entity
Organization
Contact information
Practice address
2095 HENRY TECKLENBURG DR, CHARLESTON, SC 29414-5733
(843) 402-1000
Mailing address
PO BOX 93, LANDISVILLE, PA 17538-0093
(800) 800-1617
(866) 759-5426
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
NULL
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122771300
DEPT OF LABOR
SC
01
—
83059945
BLUE SHEILD
SC
01
—
DA3021
RR MEDICARE
SC
05
—
GP3724
—
SC
Enumeration date
09/30/2006
Last updated
10/01/2013
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