Healthcare Provider Details

I. General information

NPI: 1134024102
Provider Name (Legal Business Name): HUB CITY ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 REBECCA AVE
HATTIESBURG MS
39401-3921
US

IV. Provider business mailing address

402 REBECCA AVE
HATTIESBURG MS
39401-3921
US

V. Phone/Fax

Practice location:
  • Phone: 601-297-7629
  • Fax:
Mailing address:
  • Phone: 601-297-7629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID J WARE II
Title or Position: SOLE MEMBER/OWNER
Credential: CRNA
Phone: 601-297-7629