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General NPI Number Information
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NPI Number | 1669263976
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Entity Type | Organization
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Legal Business Name | FORT PAYNE ANESTHESIA SERVICES LLC
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 200 MEDICAL CENTER DR SW
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City | FORT PAYNE
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State | AL
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Zip | 35968-3458
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Country | US
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Telephone | 660-826-5960
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1547
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City | SEDALIA
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State | MO
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Zip | 65302-1547
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Country | US
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Telephone | 660-826-5960
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROBERT CLEMENS
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Credential | MD, PHD
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Telephone | 660-826-5960
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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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Taxonomy #2
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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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