Healthcare Provider Details

I. General information

NPI: 1871058792
Provider Name (Legal Business Name): NORTH MISSISSIPPI ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 S GLOSTER ST STE B
TUPELO MS
38801-6535
US

IV. Provider business mailing address

2808 S INGRAM MILL RD BLDG B
SPRINGFIELD MO
65804-4017
US

V. Phone/Fax

Practice location:
  • Phone: 662-266-1670
  • Fax:
Mailing address:
  • Phone: 417-889-2040
  • Fax: 417-719-7896

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: ROBERT E MCCARVILLE
Title or Position: ADMINISTRATOR
Credential:
Phone: 662-432-1490