Provider Demographics
NPI:1720306293
Name:CAPITAL ANESTHESIA LLC
Entity Type:Organization
Organization Name:CAPITAL ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:405-501-4244
Mailing Address - Street 1:2828 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-8954
Mailing Address - Country:US
Mailing Address - Phone:405-501-4244
Mailing Address - Fax:405-364-5379
Practice Address - Street 1:419 W GRAY ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-7117
Practice Address - Country:US
Practice Address - Phone:405-809-4200
Practice Address - Fax:405-364-5379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-08
Last Update Date:2010-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty