Provider Demographics
NPI:1184231623
Name:PRIME ANESTHESIA PLLC
Entity Type:Organization
Organization Name:PRIME ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:501-593-5223
Mailing Address - Street 1:3711 STILLMAN LOOP
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-9074
Mailing Address - Country:US
Mailing Address - Phone:501-593-5223
Mailing Address - Fax:
Practice Address - Street 1:3711 STILLMAN LOOP
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-9074
Practice Address - Country:US
Practice Address - Phone:501-593-5223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty