Provider Demographics
NPI:1619916533
Name:MCCOMB ANESTHESIA ASSOCIATES, LLP
Entity Type:Organization
Organization Name:MCCOMB ANESTHESIA ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:E
Authorized Official - Last Name:RIAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-936-0682
Mailing Address - Street 1:PO BOX 4507
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39296-4507
Mailing Address - Country:US
Mailing Address - Phone:601-936-0682
Mailing Address - Fax:601-936-0686
Practice Address - Street 1:215 MARION AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2705
Practice Address - Country:US
Practice Address - Phone:601-936-0682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2010-02-17
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
MS09014655Medicaid
CN3408OtherRAILROAD MEDICARE
CN3408OtherRAILROAD MEDICARE