Healthcare Provider Details

I. General information

NPI: 1053372227
Provider Name (Legal Business Name): JASPER ANESTHESIA CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 HIGHWAY 78 E
JASPER AL
35501-8956
US

IV. Provider business mailing address

PO BOX 235022
MONTGOMERY AL
36123-5022
US

V. Phone/Fax

Practice location:
  • Phone: 205-387-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEE JAY CRUMPTON
Title or Position: CLIENT MANAGER
Credential:
Phone: 334-396-6930