Provider Demographics
NPI:1699179903
Name:CAROLINA BAYS ANESTHESIA, P.C.
Entity type:Organization
Organization Name:CAROLINA BAYS ANESTHESIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-527-5630
Mailing Address - Street 1:PO BOX 2370
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-2370
Mailing Address - Country:US
Mailing Address - Phone:910-527-5630
Mailing Address - Fax:
Practice Address - Street 1:4901 DAWN DR
Practice Address - Street 2:SUITE 1100
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28360-8207
Practice Address - Country:US
Practice Address - Phone:910-887-2361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33076207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty