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General NPI Number Information
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NPI Number | 1275649055
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Entity Type | Organization
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Legal Business Name | SUMMIT ANESTHESIA CONSULTING, LLC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4401 RIVER CHASE DR
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City | PHENIX CITY
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State | AL
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Zip | 36867-7483
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Country | US
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Telephone | 334-732-3000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 235022
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City | MONTGOMERY
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State | AL
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Zip | 36123-5022
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Country | US
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Telephone | 334-396-6930
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Fax | 334-396-6929
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Authorized Official
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Title or Position | MANAGING EMPLOYEE
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Name | BILL BERRYMAN
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Credential | M.D.
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Telephone | 334-732-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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