Provider Demographics
NPI:1275754103
Name:IRWIN COUNTY ANESTHESIA, INC.
Entity Type:Organization
Organization Name:IRWIN COUNTY ANESTHESIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JURAN
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:912-389-1518
Mailing Address - Street 1:206 WARD ST E
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-4600
Mailing Address - Country:US
Mailing Address - Phone:912-389-1518
Mailing Address - Fax:912-389-1518
Practice Address - Street 1:710 N IRWIN AVE
Practice Address - Street 2:
Practice Address - City:OCILLA
Practice Address - State:GA
Practice Address - Zip Code:31774-5011
Practice Address - Country:US
Practice Address - Phone:912-389-1518
Practice Address - Fax:912-389-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty