Healthcare Provider Details

I. General information

NPI: 1619087319
Provider Name (Legal Business Name): SOUTHEAST ANESTHESIA ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7191 CAHABA VALLEY RD SUITE 200
BIRMINGHAM AL
35242-6402
US

IV. Provider business mailing address

PO BOX 660257
BIRMINGHAM AL
35266-0257
US

V. Phone/Fax

Practice location:
  • Phone: 205-408-9787
  • Fax: 205-408-3993
Mailing address:
  • Phone: 205-979-5882
  • Fax: 205-979-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JASON WILLIAM COMBS
Title or Position: CO-OWNER
Credential: CRNA
Phone: 205-213-8420