Healthcare Provider Details

I. General information

NPI: 1619916533
Provider Name (Legal Business Name): MCCOMB ANESTHESIA ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MARION AVE
MCCOMB MS
39648-2705
US

IV. Provider business mailing address

PO BOX 4507
JACKSON MS
39296-4507
US

V. Phone/Fax

Practice location:
  • Phone: 601-936-0682
  • Fax:
Mailing address:
  • Phone: 601-936-0682
  • Fax: 601-936-0686

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: ASHRAF E. RIAD
Title or Position: PARTNER
Credential: M.D.
Phone: 601-936-0682