# CHARLESTON ANESTHESIA GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578656948
- **Authorized official:** ALAN DALE HILLIARD (CFO)
- **Authorized official phone:** (336) 884-1830

## Contact information

- **Practice address:** 2095 HENRY TECKLENBURG DR, CHARLESTON, SC 29414-5733
- **Practice address phone:** (843) 402-1000
- **Mailing address:** PO BOX 93, LANDISVILLE, PA 17538-0093
- **Mailing address phone:** (800) 800-1617
- **Mailing address fax:** (866) 759-5426

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/30/2006
- **Last updated:** 10/01/2013

## 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 |