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General NPI Number Information
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NPI Number | 1558102772
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Entity Type | Organization
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Legal Business Name | PHYSICIANS ANESTHESIA GROUP STAFFING, LLC
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 05/12/2026
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Provider Practice Location Address
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Address Line | 971 LAKELAND DR STE 202
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City | JACKSON
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State | MS
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Zip | 39216-4607
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Country | US
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Telephone | 601-362-1990
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Fax |
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Provider Business Mailing Address
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Address Line | 7956 VAUGHN RD STE 165
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City | MONTGOMERY
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State | AL
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Zip | 36116-6819
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Country | US
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Telephone | 601-277-0060
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Fax | 866-502-1008
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Authorized Official
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Title or Position | MANAGER
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Name | RYAN BRUCE WEATHERS
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Credential |
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Telephone | 334-425-1583
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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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Taxonomy #2
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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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