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NPI Code Detail

MEDICARE: DELTA REGIONAL ANESTHESIOLOGY GROUP

MEDICARE: DELTA REGIONAL ANESTHESIOLOGY GROUP
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
2207L00000XAnesthesiology Physician

General Provider Information

NPI Number : 1720059249
Entity Type Code : Organization
Provider Name (Legal Business Name) : DELTA REGIONAL ANESTHESIOLOGY GROUP
Provider Business Mailing Address
First Line : PO BOX 235019
Second Line :
City : MONTGOMERY
State : AL
Zip : 36123-5019
Country : US
Telephone Number : 800-232-5703
Fax Number :
Provider Business Practice Location Address
First Line : 1400 E UNION ST
Second Line :
City : GREENVILLE
State : MS
Zip : 38703-3246
Country : US
Telephone Number : 662-334-2005
Fax Number : 662-334-2189
Authorized Official
Title or Position : PHYSICIAN RECRUITMENT COORDINATOR
Name : LEE ANN BOWLIN
Credential :
Telephone Number : 662-334-2005
Provider Enumeration Date : 02/01/2006
Last Update Date : 04/22/2008

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