Healthcare Provider Details

I. General information

NPI: 1750300836
Provider Name (Legal Business Name): ANESTHESIA CONSULTANTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 RIVER OAKS DR RIVER OAKS HEALTH SYSTEM
JACKSON MS
39208
US

IV. Provider business mailing address

2550 FLOWOOD DRIVE STE 400
FLOWOOD MS
39232
US

V. Phone/Fax

Practice location:
  • Phone: 601-932-1030
  • Fax:
Mailing address:
  • Phone: 601-933-9521
  • Fax: 601-933-9525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateMS

VIII. Authorized Official

Name: DR. PAUL W PICKARD
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 601-933-9521