Provider Demographics
NPI:1144428830
Name:METROPOLITAN ANESTHESIA ALLIANCE, CRNA
Entity Type:Organization
Organization Name:METROPOLITAN ANESTHESIA ALLIANCE, CRNA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCE ASSOCIATE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROENBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-818-2162
Mailing Address - Street 1:1900 EXETER RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2954
Mailing Address - Country:US
Mailing Address - Phone:901-818-2162
Mailing Address - Fax:901-818-2163
Practice Address - Street 1:1900 EXETER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2954
Practice Address - Country:US
Practice Address - Phone:901-818-2162
Practice Address - Fax:901-818-2163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3625251Medicaid
TN3625251Medicaid