MEDICARE: SUMMIT ANESTHESIA CONSULTING, LLC

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

General Provider Information

NPI Number	:	1275649055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT ANESTHESIA CONSULTING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 235022
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36123-5022
Country	:	US
Telephone Number	:	334-396-6930
Fax Number	:	334-396-6929

Provider Business Practice Location Address
First Line	:	4401 RIVER CHASE DR
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-7483
Country	:	US
Telephone Number	:	334-732-3000
Fax Number	:

Authorized Official
Title or Position	:	MANAGING EMPLOYEE
Name	:	BILL BERRYMAN
Credential	:	M.D.
Telephone Number	:	334-732-3000

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

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