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NPI Code Detail

MEDICARE: ETHER BUNNY INC

MEDICARE: ETHER BUNNY 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
1207LP2900XPain Medicine (Anesthesiology) Physician
2207L00000XAnesthesiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306843305
Entity Type Code : Organization
Provider Name (Legal Business Name) : ETHER BUNNY INC
Provider Business Mailing Address
First Line : PO BOX 969
Second Line :
City : MAGNOLIA SPRINGS
State : AL
Zip : 36555-0969
Country : US
Telephone Number : 251-965-5393
Fax Number : 251-971-1029
Provider Business Practice Location Address
First Line : 1613 N MCKENZIE ST
Second Line :
City : FOLEY
State : AL
Zip : 36535-2247
Country : US
Telephone Number : 251-965-5393
Fax Number : 251-971-1029
Authorized Official
Title or Position : BILLING CONTACT
Name : MRS. DEBRA LEE DESVERREAUX
Credential :
Telephone Number : 251-965-5393
Provider Enumeration Date : 07/05/2005
Last Update Date : 04/07/2009

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Directions to “ETHER BUNNY INC ” Practice Location

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