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NPI Code Detail

MEDICARE: MEDICAL ANESTHESIA SERVICES, LLC

MEDICARE: MEDICAL ANESTHESIA SERVICES, 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
1367500000XCertified Registered Nurse Anesthetist

General Provider Information

NPI Number : 1598221616
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDICAL ANESTHESIA SERVICES, LLC
Provider Business Mailing Address
First Line : 3623 W HOWARD NICKELL RD
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72704-5479
Country : US
Telephone Number : 941-376-1242
Fax Number :
Provider Business Practice Location Address
First Line : 3394 N FUTRALL DR
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-4057
Country : US
Telephone Number : 479-582-3360
Fax Number :
Authorized Official
Title or Position : CRNA
Name : VICTOR PRIBISLAVSKI
Credential : CRNA, DNP
Telephone Number : 941-376-1242
Provider Enumeration Date : 02/13/2019
Last Update Date : 03/31/2024

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Directions to “MEDICAL ANESTHESIA SERVICES, LLC ” Practice Location

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