MEDICARE: COVENANT ANESTHESIA PC

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	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1780040592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVENANT ANESTHESIA PC

Provider Business Mailing Address
First Line	:	2000 STONEGATE TRL STE 112
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-2237
Country	:	US
Telephone Number	:	205-979-5882
Fax Number	:	205-979-1248

Provider Business Practice Location Address
First Line	:	2000 STONEGATE TRL STE 112
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-2237
Country	:	US
Telephone Number	:	205-979-5882
Fax Number	:	205-979-1248

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIAN K MCNIEL
Credential	:
Telephone Number	:	205-317-4622

Provider Enumeration Date	:	01/08/2016
Last Update Date	:	01/26/2016

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