Healthcare Provider Details

I. General information

NPI: 1801148655
Provider Name (Legal Business Name): DAVIS ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 07/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 OUACHITA ROAD 67
LOUANN AR
71751-8630
US

IV. Provider business mailing address

3320 OUACHITA ROAD 67
LOUANN AR
71751-8630
US

V. Phone/Fax

Practice location:
  • Phone: 870-725-6262
  • Fax: 870-725-3041
Mailing address:
  • Phone: 870-725-6262
  • Fax: 870-725-3041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC02767
License Number StateAR

VIII. Authorized Official

Name: STEVEN R DAVIS
Title or Position: SOLE MEMBER
Credential: CRNA
Phone: 870-725-6262