Provider Demographics
NPI:1871058792
Name:NORTH MISSISSIPPI ANESTHESIA, LLC
Entity type:Organization
Organization Name:NORTH MISSISSIPPI ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCCARVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-432-1490
Mailing Address - Street 1:2808 S INGRAM MILL RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4017
Mailing Address - Country:US
Mailing Address - Phone:417-889-2040
Mailing Address - Fax:417-719-7896
Practice Address - Street 1:1211 S GLOSTER ST STE B
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6535
Practice Address - Country:US
Practice Address - Phone:662-266-1670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty