Provider Demographics
NPI:1538171897
Name:SALEM PROFESSIONAL ANESTHESIA SERVICES PC
Entity type:Organization
Organization Name:SALEM PROFESSIONAL ANESTHESIA SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:NITZ
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:336-998-3396
Mailing Address - Street 1:128 PEACHTREE LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:ADVANCE
Mailing Address - State:NC
Mailing Address - Zip Code:27006-6782
Mailing Address - Country:US
Mailing Address - Phone:336-998-3396
Mailing Address - Fax:336-998-2889
Practice Address - Street 1:3812 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2596
Practice Address - Country:US
Practice Address - Phone:336-294-1833
Practice Address - Fax:336-998-2889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC16186OtherPARTNERS
NC890264UMedicaid
NC0264UOtherBCBS
NC2600253Medicare PIN
NC0264UOtherBCBS