MEDICARE: JASPER ANESTHESIA CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	J913	OTHER	AL	MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DB5370	OTHER	AL	MCTR GROUP #
2	F859	OTHER	AL	BCBS CLINIC ID

General Provider Information

NPI Number	:	1053372227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASPER ANESTHESIA CARE, INC

Provider Business Mailing Address
First Line	:	PO BOX 235022
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36123-5022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 HIGHWAY 78 E
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35501-8956
Country	:	US
Telephone Number	:	205-387-4000
Fax Number	:

Authorized Official
Title or Position	:	CLIENT MANAGER
Name	:	DEE JAY CRUMPTON
Credential	:
Telephone Number	:	334-396-6930

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	08/22/2020

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Directions to “JASPER ANESTHESIA CARE, INC ” Practice Location

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