Mr Jed Dean Zak, CRNA | |
801 Goodyear Blvd, Picayune, MS 39466-3221 | |
(601) 798-4711 | |
Not Available |
Full Name | Mr Jed Dean Zak |
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Gender | Male |
Speciality | Nurse Anesthetist, Certified Registered |
Location | 801 Goodyear Blvd, Picayune, Mississippi |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1053447037 | NPI | - | NPPES |
336508YYGZ | Other | MS | MEDICARE |
01689315 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
367500000X | Nurse Anesthetist, Certified Registered | R867178 (Mississippi) | Primary |
Entity Name | Forrest County General Hospital |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1295837631 PECOS PAC ID: 1052397767 Enrollment ID: O20040624001351 |
Entity Name | Deep South Anesthesia, Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1164738712 PECOS PAC ID: 4284897612 Enrollment ID: O20120523000317 |
Mailing Address | Practice Location Address |
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Mr Jed Dean Zak, CRNA 26 N Hill Dr W, Carriere, MS 39426-8147 Ph: (601) 749-5976 | Mr Jed Dean Zak, CRNA 801 Goodyear Blvd, Picayune, MS 39466-3221 Ph: (601) 798-4711 |
Mr. Milton Nicholas Dudenhefer Iii, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 801 Goodyear Blvd, Picayune, MS 39466 Phone: 601-798-4711 Fax: 601-749-3187 | |
Mr. Vincent Guy Lombardo, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 801 Goodyear Blvd, Picayune, MS 39466 Phone: 601-798-4711 Fax: 601-749-3187 |