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General NPI Number Information
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NPI Number | 1063873438
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Entity Type | Organization
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Legal Business Name | HOLDER ANESTHESIA
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Dates
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Enumeration Date | 03/14/2016
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Last Update Date | 03/21/2016
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Provider Practice Location Address
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Address Line | 2311 JACKSON AVE W SUITE 302
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City | OXFORD
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State | MS
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Zip | 38655-5750
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Country | US
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Telephone | 662-612-0063
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Fax | 662-580-4324
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Provider Business Mailing Address
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Address Line | PO BOX 1596
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City | OXFORD
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State | MS
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Zip | 38655-1596
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Country | US
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Telephone | 662-550-4299
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Fax | 662-580-4324
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Authorized Official
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Title or Position | OWNER
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Name | PENNEYE HOLDER
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Credential | CRNA
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Telephone | 662-550-4299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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