Basic Information
| Provider Information | |||||||||
| NPI: | 1285100594 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JMJ ANESTHESIA PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 544 COUNTY ROAD 176 | ||||||||
| Address2: | |||||||||
| City: | MOULTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356505767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154281594 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15155 HIGHWAY 43 | ||||||||
| Address2: | |||||||||
| City: | RUSSELLVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356531975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563321611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2018 | ||||||||
| LastUpdateDate: | 10/15/2018 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | PHILIP | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6154281594 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 20181173 | 01 | AL | ANESTHESIA | OTHER |