Provider Demographics
NPI:1457317513
Name:ANESTHESIA HEALTH CARE AUTHORITY
Entity Type:Organization
Organization Name:ANESTHESIA HEALTH CARE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-930-7100
Mailing Address - Street 1:PO BOX 55905
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5905
Mailing Address - Country:US
Mailing Address - Phone:205-979-5882
Mailing Address - Fax:205-979-1248
Practice Address - Street 1:1201 11TH AVE S
Practice Address - Street 2:ANESTHESIA DEPT.
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-3423
Practice Address - Country:US
Practice Address - Phone:205-930-7296
Practice Address - Fax:205-930-7256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529928370Medicaid
ALDE7328OtherRAILROAD MEDICARE GROUP #
ALK849Medicare PIN