Organization
TAILORED ANESTHESIA SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY G TAYLOR CRNA (OWNER)
(301) 538-5352
Entity
Organization
Contact information
Practice address
3810 WATERSIDE DR APT 104, ELIZABETH CITY, NC 27909-9739
(301) 538-5352
(252) 621-1003
Mailing address
3810 WATERSIDE DR APT 104, ELIZABETH CITY, NC 27909-9739
(301) 538-5352
(252) 621-1003
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
158154
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15202003000152
DCN
NC
01
—
Q45087E830
PROVIDER PTAN
NC
Enumeration date
08/18/2015
Last updated
09/08/2015
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