Provider Demographics
NPI:1447332937
Name:MILLENNIUM ANESTHESIA SERVICES
Entity type:Organization
Organization Name:MILLENNIUM ANESTHESIA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-635-0991
Mailing Address - Street 1:P.O. BOX 681268
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968
Mailing Address - Country:US
Mailing Address - Phone:256-635-0991
Mailing Address - Fax:256-635-0992
Practice Address - Street 1:1701 PELHAM ROAD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265
Practice Address - Country:US
Practice Address - Phone:256-635-0991
Practice Address - Fax:256-635-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty