Organization
METROLINA ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RON C DEATLEY CRNA (VICE PRESIDENT)
(704) 604-8206
Entity
Organization
Contact information
Practice address
800 W MEETING ST, LANCASTER, SC 29720-2202
(803) 286-1214
Mailing address
8000 CORPORATE CENTER DR, SUITE 208, CHARLOTTE, NC 28226-4464
(704) 540-4350
(888) 422-9661
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DH2057
RR MEDICARE
SC
Enumeration date
10/30/2007
Last updated
02/26/2009
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