| Southerncare Anesthetics Llc | |
|
4 Willow Pt Ste 1b Hattiesburg MS 39402-1150 | |
| (601) 582-6069 | |
| Not Available |
| Full Name | Southerncare Anesthetics Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4 Willow Pt Ste 1b, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Jory Scott (OWNER) |
| Authorized Official Contact | 6015826069 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southerncare Anesthetics Llc 4 Willow Pt Ste 50 Hattiesburg MS 39402-1150 Ph: () - | Southerncare Anesthetics Llc 4 Willow Pt Ste 1b Hattiesburg MS 39402-1150 Ph: (601) 582-6069 |
| NPI Number | 1043908015 |
|---|---|
| Provider Enumeration Date | 04/27/2023 |
| Last Update Date | 04/27/2023 |
| Medicare PECOS PAC ID | 0941668834 |
|---|---|
| Medicare Enrollment ID | O20230626001139 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043908015 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Graham T Gardner |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1306272976 PECOS PAC ID: 1759510225 Enrollment ID: I20140203000444 |
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