NPIMap

Organization Active NPI

Avvc Anesthesia, LLC

  • Medical Specialty Clinic/Center
  • Lawrenceville, GA
National Provider Identifier
1982074431
Registry record updated Sep 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
AVVC ANESTHESIA, LLC
Practice address
600 Professional Dr
Suite 160a
Lawrenceville, GA 30046-7651
Phone
(678) 878-4555
NPI assigned
Sep 28, 2015
Last updated
Sep 28, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amish Tilara, MDNPI 1912221359
Title
President
Phone
(973) 632-8372

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X NU Primary

Addresses

Primary practice location

600 Professional Dr
Suite 160a
Lawrenceville, GA 30046-7651

Mailing address

1873 Royal Troon CT
Duluth, GA 30097-5234

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160621002690 GA Part B Supplier - Clinic/Group Practice 7719278852 Receives reassigned benefits from 18 practitioners
Practice locations: Lawrenceville, GA

National Provider Directory

National Provider Directory

Locations

600 Professional Dr
Ste 160B
Lawrenceville, GA 30046
Phone (678) 878-4555

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1443398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443398400000",
    "number": "1982074431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1873 ROYAL TROON CT",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300975234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 PROFESSIONAL DR",
            "address_2": "SUITE 160A",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300467651",
            "telephone_number": "678-878-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVVC ANESTHESIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-28",
        "last_updated": "2015-09-28",
        "status": "A",
        "authorized_official_last_name": "TILARA",
        "authorized_official_first_name": "AMISH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "973-632-8372",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.