1720059249 NPI number — DELTA REGIONAL ANESTHESIOLOGY GROUP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720059249 NPI number — DELTA REGIONAL ANESTHESIOLOGY GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELTA REGIONAL ANESTHESIOLOGY GROUP
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:
1720059249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 235019
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36123-5019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-232-5703
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 E UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38703-3246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-334-2005
Provider Business Practice Location Address Fax Number:
662-334-2189
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOWLIN
Authorized Official First Name:
LEE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PHYSICIAN RECRUITMENT COORDINATOR
Authorized Official Telephone Number:
662-334-2005

Provider Taxonomy Codes

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

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





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