Healthcare Provider Details

I. General information

NPI: 1275649055
Provider Name (Legal Business Name): SUMMIT ANESTHESIA CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

4401 RIVER CHASE DR
PHENIX CITY AL
36867-7483
US

IV. Provider business mailing address

PO BOX 235022
MONTGOMERY AL
36123-5022
US

V. Phone/Fax

Practice location:
  • Phone: 334-732-3000
  • Fax:
Mailing address:
  • Phone: 334-396-6930
  • Fax: 334-396-6929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BILL BERRYMAN
Title or Position: MANAGING EMPLOYEE
Credential: M.D.
Phone: 334-732-3000