Provider Demographics
NPI:1871701029
Name:HARTSVILLE ANESTHESIA ASSOCIATES
Entity type:Organization
Organization Name:HARTSVILLE ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-724-7495
Mailing Address - Street 1:315 CHURCHILL RD
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4015
Mailing Address - Country:US
Mailing Address - Phone:803-724-7495
Mailing Address - Fax:803-724-7495
Practice Address - Street 1:315 CHURCHILL RD
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4015
Practice Address - Country:US
Practice Address - Phone:803-749-8585
Practice Address - Fax:803-749-8909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-20
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5152Medicare PIN