Mississippi Anesthesia Group, LLC
Nurse Anesthetist, Certified Registered in Canton, MS. Organization (NPI-2).
NPI number1366845554
StatusActive
Last updated in NPPESOct 1, 2014
Details
- NPI
- 1366845554
- Entity type
- Organization (NPI-2)
- Legal business name
- Mississippi Anesthesia Group, LLC
- Organization subpart
- No
- Enumeration date
- Oct 1, 2014
- Last updated
- Oct 1, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | R598755 | MS | Yes |
Practice location
145 Sanctuary LnCanton, MS 39046-6601
Phone 601-855-7440
Mailing address
2714 W Oxford LoopSte 161
Oxford, MS 38655-5711
Phone 662-550-4299 · Fax 662-580-4324
Authorized official
Gary Dwayne Self
Founder And President
6016685628
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Checking a whole list?
Paste up to 5,000 NPIs and download status, name, taxonomy, license and address for each one. Useful for credentialing, billing and pharmacy claim checks.