Basic Information
| Provider Information | |||||||||
| NPI: | 1265485742 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANESTHESIA CONSULTANTS OF OXFORD, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 235022 | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361235022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343862053 | ||||||||
| FaxNumber: | 3342441830 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 S LAMAR BLVD | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386555373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343862056 | ||||||||
| FaxNumber: | 3342441830 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 10/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | CARLETON | ||||||||
| AuthorizedOfficialFirstName: | TERRIE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | ACCOUNT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3343862053 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 09015006 | 05 | MS | MEDICAID | CI8573 | 01 | MS | RAILROAD MEDICARE PROV # | OTHER |