Basic Information
| Provider Information | |||||||||
| NPI: | 1811368327 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JONESBORO ANESTHESIA SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5426 BAY CENTER DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336093444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8135696500 | ||||||||
| FaxNumber: | 8138644030 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 E MATTHEWS AVE | ||||||||
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| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724013145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709356396 | ||||||||
| FaxNumber: | 9709354063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2015 | ||||||||
| LastUpdateDate: | 10/15/2015 | ||||||||
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| AuthorizedOfficialLastName: | PARKS | ||||||||
| AuthorizedOfficialFirstName: | JEFF | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF OPERATIONS & ANESTHESIOLOGY | ||||||||
| AuthorizedOfficialTelephone: | 8135696500 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SURGERY CENTER HOLDINGS INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 367500000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.