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General NPI Number Information
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NPI Number | 1720306293
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Entity Type | Organization
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Legal Business Name | CAPITAL ANESTHESIA LLC
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Dates
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Enumeration Date | 05/08/2010
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Last Update Date | 05/08/2010
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Provider Practice Location Address
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Address Line | 419 W GRAY ST
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City | NORMAN
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State | OK
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Zip | 73069-7117
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Country | US
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Telephone | 405-809-4200
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Fax | 405-364-5379
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Provider Business Mailing Address
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Address Line | 2828 NW 167TH ST
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City | EDMOND
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State | OK
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Zip | 73012-8954
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Country | US
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Telephone | 405-501-4244
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Fax | 405-364-5379
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Authorized Official
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Title or Position | PARTNER
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Name | BRIAN MACKEY
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Credential | CRNA
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Telephone | 405-501-4244
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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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