1780805564 NPI number — JASON SIRNY CRNA

Table of content: JASON SIRNY CRNA (NPI 1780805564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780805564 NPI number — JASON SIRNY CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIRNY
Provider First Name:
JASON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

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:
1780805564
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1845 LINCOLN ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-955-5769
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 PLUM
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-955-5769
Provider Business Practice Location Address Fax Number:
478-955-5769
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN169127 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 440677502A . This is a "PEACHSTATE CMO - MCCG" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 344393 . This is a "WELLCARE CMO - MCCG" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 440677502A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00147040 . This is a "RAILROAD MCR - MCCG" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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