=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417517640
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JASPER ANESTHESIA CARE ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2019
-----------------------------------------------------
Last Update Date | 07/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 647 W 2ND ST STE A
-----------------------------------------------------
City | JASPER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47546-3243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-556-5048
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3414 PEACHTREE RD NE STE 340
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30326-1137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-803-3885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF RCM
-----------------------------------------------------
Name | JEFF PERRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-418-4700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------