Healthcare Provider Details

I. General information

NPI: 1669474672
Provider Name (Legal Business Name): TOMBIGBEE ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 LEIGH DR
COLUMBUS MS
39705-3014
US

IV. Provider business mailing address

PO BOX 9235
COLUMBUS MS
39705-0017
US

V. Phone/Fax

Practice location:
  • Phone: 662-327-6820
  • Fax: 662-327-9388
Mailing address:
  • Phone: 662-327-6820
  • Fax: 662-327-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: EDITH SHELTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 662-327-6820