Provider Demographics
NPI:1457807794
Name:FREELANCE ANESTHESIA MISSISSIPPI, LLC
Entity Type:Organization
Organization Name:FREELANCE ANESTHESIA MISSISSIPPI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMALA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNAP,CRNA
Authorized Official - Phone:918-704-5556
Mailing Address - Street 1:327 S. GAMWYN PARK DR.
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701
Mailing Address - Country:US
Mailing Address - Phone:601-918-5567
Mailing Address - Fax:866-550-2242
Practice Address - Street 1:1746 HIGHWAY 1 S STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-7817
Practice Address - Country:US
Practice Address - Phone:662-743-9809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREELANCE ANESTHESIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR31793367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty