Provider Demographics
NPI:1487945374
Name:MCKENZIE ANESTHESIA CARE LLC
Entity type:Organization
Organization Name:MCKENZIE ANESTHESIA CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:843-319-3271
Mailing Address - Street 1:1279 OLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-5351
Mailing Address - Country:US
Mailing Address - Phone:843-319-3271
Mailing Address - Fax:843-676-0493
Practice Address - Street 1:258 N RON MCNAIR BLVD
Practice Address - Street 2:DEPT OF ANES
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-2462
Practice Address - Country:US
Practice Address - Phone:843-374-2036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC053354367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty