Provider Demographics
NPI:1275749228
Name:NURSE ANESTHESIA PROVIDERS, INC
Entity Type:Organization
Organization Name:NURSE ANESTHESIA PROVIDERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SEALE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:601-260-2350
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39043-0085
Mailing Address - Country:US
Mailing Address - Phone:601-260-2350
Mailing Address - Fax:601-706-4175
Practice Address - Street 1:3353 N GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-9735
Practice Address - Country:US
Practice Address - Phone:662-407-0334
Practice Address - Fax:662-407-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR686891207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS426332234BOtherBCBS OF MS
MS1275512410OtherINDIVIDUAL NPI
MS08508830Medicaid
MSP00367222OtherRR MEDICARE
MS=========OtherTRICARE
MS08508830Medicaid
MS430002110Medicare PIN