Provider Demographics
NPI:1386679744
Name:CLARKSDALE HMA LLC
Entity Type:Organization
Organization Name:CLARKSDALE HMA LLC
Other - Org Name:CLARKSDALE PHYS SERV ANESTHESIA CRNA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PHYSICIAN BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-778-8074
Mailing Address - Street 1:1970 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-7202
Mailing Address - Country:US
Mailing Address - Phone:662-624-3401
Mailing Address - Fax:
Practice Address - Street 1:1970 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-7202
Practice Address - Country:US
Practice Address - Phone:662-624-3401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000019315AOtherBC CRNA
MS090114363Medicaid
MS=========AOtherBC ANESTHESIOLOGIST
MS=========AOtherBC ANESTHESIOLOGIST