1346287281 NPI number — SURGICAL ANESTHESIA ASSOCIATES, PA

Table of content: MS. CLAUDIA RENEE JOHNSON LMFT (NPI 1134211758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346287281 NPI number — SURGICAL ANESTHESIA ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL ANESTHESIA ASSOCIATES, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346287281
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7539
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39284-7539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-376-1848
Provider Business Mailing Address Fax Number:
601-376-1894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 CHADWICK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39204-3404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-376-1848
Provider Business Practice Location Address Fax Number:
601-376-1894
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAY
Authorized Official First Name:
TABITHA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
601-376-1848

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 09016165 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09013711 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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