Healthcare Provider Details

I. General information

NPI: 1689129504
Provider Name (Legal Business Name): BKT ANESTHESIA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2016
Last Update Date: 11/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 MARKET PLZ 304
MONTGOMERY AL
36104-3943
US

IV. Provider business mailing address

44 MARKET PLZ 304
MONTGOMERY AL
36104-3943
US

V. Phone/Fax

Practice location:
  • Phone: 228-990-4830
  • Fax:
Mailing address:
  • Phone: 228-990-4830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-115992
License Number StateAL

VIII. Authorized Official

Name: MR. BRIAN K TANNER
Title or Position: CRNA
Credential: CRNA
Phone: 228-990-4830