Basic Information
| Provider Information | |||||||||
| NPI: | 1003838673 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REDMOND ANESTHESIOLOGY ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 REDMOND ROAD | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062910291 | ||||||||
| FaxNumber: | 7068023063 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 REDMOND ROAD | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062910291 | ||||||||
| FaxNumber: | 7068023063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | WURL | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8282541969 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 20-23868809 | 05 | GA | MEDICAID | GRP7107 | 01 | GA | MEDICARE GROUP # | OTHER | 20-23868809 | 01 | GA | BCBS GA | OTHER |