Basic Information
Provider Information
NPI: 1245201771
EntityType: 2
ReplacementNPI:  
OrganizationName: ANESTHESIA ASSOCIATES OF EAST ALABAMA LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: P GEORGE PURVES ET AL PTRS
OtherOrganizationType: 5
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 235019
Address2:  
City: MONTGOMERY
State: AL
PostalCode: 361235019
CountryCode: US
TelephoneNumber: 3342791450
FaxNumber: 3342791660
Practice Location
Address1: 2000 PEPPERELL PKWY
Address2:  
City: OPELIKA
State: AL
PostalCode: 368015452
CountryCode: US
TelephoneNumber: 3347052499
FaxNumber: 3347022497
Other Information
ProviderEnumerationDate: 02/01/2006
LastUpdateDate: 06/12/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: THOMPSON
AuthorizedOfficialFirstName: TERESA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: MANAGER
AuthorizedOfficialTelephone: 3345282499
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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