Basic Information
| Provider Information | |||||||||
| NPI: | 1871533398 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MURRAY ANESTHESIA GROUP, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 W MICHIGAN AVE | ||||||||
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| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492012218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177876440 | ||||||||
| FaxNumber: | 5177874146 | ||||||||
| Practice Location | |||||||||
| Address1: | 803 POPLAR ST | ||||||||
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| City: | MURRAY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420712432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707621100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 09/20/2007 | ||||||||
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| AuthorizedOfficialLastName: | YATES | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED REPRESENTATIVE | ||||||||
| AuthorizedOfficialTelephone: | 2707621100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 74901059 | 05 | KY | MEDICAID | 65945917 | 05 | KY | MEDICAID |