Provider Demographics
NPI:1821225475
Name:SOUTHERN ANESTHETICS, PLLC
Entity Type:Organization
Organization Name:SOUTHERN ANESTHETICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CHARLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-892-4600
Mailing Address - Street 1:755 NORTH 11TH STREET
Mailing Address - Street 2:P2280
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1525
Mailing Address - Country:US
Mailing Address - Phone:409-892-4600
Mailing Address - Fax:409-892-4605
Practice Address - Street 1:755 NORTH 11TH STREET
Practice Address - Street 2:P2280
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1525
Practice Address - Country:US
Practice Address - Phone:409-892-4600
Practice Address - Fax:409-892-4605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty