Healthcare Provider Details

I. General information

NPI: 1427010164
Provider Name (Legal Business Name): RURAL ANESTHESIA ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N BYRON BUTLER PKWY
PERRY FL
32347-2300
US

IV. Provider business mailing address

PO BOX 323
PERRY FL
32348-0323
US

V. Phone/Fax

Practice location:
  • Phone: 813-985-5992
  • Fax: 813-985-5982
Mailing address:
  • Phone: 813-985-5992
  • Fax: 813-985-5982

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: DIANNE MEREDITH
Title or Position: PRESIDENT
Credential: C.R.N.A.
Phone: 813-985-5992