Healthcare Provider Details

I. General information

NPI: 1952732224
Provider Name (Legal Business Name): ANDERSON ANESTHESIA PROVIDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 14TH ST
MERIDIAN MS
39301-4040
US

IV. Provider business mailing address

PO BOX 5337
MERIDIAN MS
39302-5337
US

V. Phone/Fax

Practice location:
  • Phone: 601-485-6325
  • Fax: 601-485-3061
Mailing address:
  • Phone: 601-485-6325
  • Fax: 601-485-3061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN G ANDERSON
Title or Position: VP/ADMINISTRATOR
Credential: FACHE
Phone: 601-553-6104