Provider Demographics
NPI:1386929628
Name:MARIA PARHAM ANESTHESIA AND PHYSIATRY CENTER INC
Entity type:Organization
Organization Name:MARIA PARHAM ANESTHESIA AND PHYSIATRY CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-436-1102
Mailing Address - Street 1:568 RUIN CREEK RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2880
Mailing Address - Country:US
Mailing Address - Phone:252-436-1085
Mailing Address - Fax:252-436-1086
Practice Address - Street 1:568 RUIN CREEK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2880
Practice Address - Country:US
Practice Address - Phone:252-436-1085
Practice Address - Fax:252-436-1086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01718207R00000X
NC01275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty