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NPI Code Detail

MEDICARE: PRAIRIE ANESTHESIA, PLLC

MEDICARE: PRAIRIE ANESTHESIA, PLLC
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
1207L00000XAnesthesiology Physician

General Provider Information

NPI Number : 1508868514
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRAIRIE ANESTHESIA, PLLC
Provider Business Mailing Address
First Line : 7956 VAUGHN RD # 165
Second Line :
City : MONTGOMERY
State : AL
Zip : 36116-6625
Country : US
Telephone Number : 888-829-0068
Fax Number : 334-239-7654
Provider Business Practice Location Address
First Line : 2520 5TH ST N
Second Line :
City : COLUMBUS
State : MS
Zip : 39705-2008
Country : US
Telephone Number : 662-244-1000
Fax Number :
Authorized Official
Title or Position : PARTNER
Name : BEEKMAN LEE YOUNGBLOOD
Credential : MD
Telephone Number : 334-878-4560
Provider Enumeration Date : 08/10/2005
Last Update Date : 02/12/2020

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Directions to “PRAIRIE ANESTHESIA, PLLC ” Practice Location

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