Basic Information
| Provider Information | |||||||||
| NPI: | 1457317513 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIA HEALTH CARE AUTHORITY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 55905 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352555905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059795882 | ||||||||
| FaxNumber: | 2059791248 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 11TH AVE S | ||||||||
| Address2: | ANESTHESIA DEPT. | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352053423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059307296 | ||||||||
| FaxNumber: | 2059307256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 03/11/2010 | ||||||||
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| AuthorizedOfficialLastName: | EDWARDS | ||||||||
| AuthorizedOfficialFirstName: | J | ||||||||
| AuthorizedOfficialMiddleName: | MARK | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2059307100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 529928370 | 05 | AL | MEDICAID | DE7328 | 01 | AL | RAILROAD MEDICARE GROUP # | OTHER |