Basic Information
| Provider Information | |||||||||
| NPI: | 1700982360 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GADSDEN ANESTHESIA SERVICES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 660685 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352660685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059795882 | ||||||||
| FaxNumber: | 2059791248 | ||||||||
| Practice Location | |||||||||
| Address1: | 314 S 5TH ST | ||||||||
| Address2: | ANESTHESIA DEPT | ||||||||
| City: | GADSDEN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359014224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565434180 | ||||||||
| FaxNumber: | 2565435485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 03/12/2010 | ||||||||
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| AuthorizedOfficialLastName: | TEMPLETON | ||||||||
| AuthorizedOfficialFirstName: | FARLIE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2565435200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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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 | CK4160 | 01 | AL | GROUP RR MEDICARE | OTHER | 529913540 | 05 | AL | MEDICAID |