Provider Demographics
NPI:1811174964
Name:ECLIPSE ANESTHESIA LLC
Entity type:Organization
Organization Name:ECLIPSE ANESTHESIA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-464-2600
Mailing Address - Street 1:610 3RD ST
Mailing Address - Street 2:STE 206
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3294
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 3RD ST
Practice Address - Street 2:STE 206
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3294
Practice Address - Country:US
Practice Address - Phone:478-464-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty