Basic Information
| Provider Information | |||||||||
| NPI: | 1700933140 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN ANESTHESIA SPECIALISTS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1074 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDER CITY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350111074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563292938 | ||||||||
| FaxNumber: | 2563292938 | ||||||||
| Practice Location | |||||||||
| Address1: | 3316 HIGHWAY 280 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDER CITY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350103369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563292938 | ||||||||
| FaxNumber: | 2563292938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2007 | ||||||||
| LastUpdateDate: | 09/07/2007 | ||||||||
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| AuthorizedOfficialLastName: | COOPER | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | NELSON | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2563292938 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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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 | Q221 | 01 | AL | BLUE CROSS | OTHER |