Provider Demographics
NPI:1790844421
Name:T M ANESTHESIA ASSOC. PC
Entity Type:Organization
Organization Name:T M ANESTHESIA ASSOC. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:YARBRO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:901-377-5546
Mailing Address - Street 1:PO BOX 280604
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38168-0604
Mailing Address - Country:US
Mailing Address - Phone:901-377-5546
Mailing Address - Fax:901-377-5546
Practice Address - Street 1:109 EUREKA ST
Practice Address - Street 2:109 MEDICAL ARTS BLDG. SUITE B
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606
Practice Address - Country:US
Practice Address - Phone:662-563-7728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09010576Medicaid
MS09010576Medicaid