Healthcare Provider Details

I. General information

NPI: 1346287281
Provider Name (Legal Business Name): SURGICAL ANESTHESIA ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 CHADWICK DR
JACKSON MS
39204-3404
US

IV. Provider business mailing address

PO BOX 7539
JACKSON MS
39284-7539
US

V. Phone/Fax

Practice location:
  • Phone: 601-376-1848
  • Fax: 601-376-1894
Mailing address:
  • Phone: 601-376-1848
  • Fax: 601-376-1894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TABITHA MAY
Title or Position: OFFICE MANAGER
Credential:
Phone: 601-376-1848