JACKSONVILLE ANESTHESIA LLC (NPI# 1205165065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205165065 |
| Entity Type | Organization |
| Organization Name | JACKSONVILLE ANESTHESIA LLC |
| Practice Address |
1701 Pelham Rd S Jacksonville AL 36265-3369 |
| Mailing Address |
Po Box 1547 Sedalia MO 65302-1547 |
| Practice Telephone | 2564354970 |
| Mailing Telephone | 6608265960 |
| Mailing Fax Number | 6608264852 |
| Enumeration Date | 2009-12-08 |
| Last Update Date | 2009-12-08 |
| Authorized Official Name | ROB CLEMENS (CEO) |
| Authorized Official Telephone | 6608265960 |
| Authorized Official Credential | MD PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207L00000X | Anesthesiology | Allopathic & Osteopathic Physicians | ||
| Y | 367500000X | Nurse Anesthetist, Certified Registered | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1701 PELHAM RD S |
| City | JACKSONVILLE |
| State | AL |
| Zip Code | 36265-3369 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508824764 | William Ernest Tyndall | Emergency Medicine | 1701 Pelham Rd S, Jacksonville, AL 36265-3353 | 2006-05-03 |
| 1679011969 | Jacksonville Internal Medicine & Wellness LLC | Legal Medicine | 1701 Pelham Rd S, Jacksonville, AL 36265-3353 | 2017-02-07 |
| 1427503010 | The Health Care Authority of The City of Anniston | Emergency Medicine | 1701 Pelham Rd S, Jacksonville, AL 36265-3353 | 2016-08-24 |
| 1982058392 | Christina Joy Latta | Nurse Practitioner | 1701 Pelham Rd S, Jacksonville, AL 36265-3353 | 2016-04-21 |
| 1316312028 | Jacksonville Aristo Er, LLC | Emergency Medicine | 1701 Pelham Rd S, Jacksonville, AL 36265-3353 | 2015-12-07 |
| 1235575622 | Stoney Brook Emergency Physicians, Pllc | Emergency Medicine | 1701 Pelham Rd S, Jacksonville, AL 36265-3369 | 2013-05-13 |
| 1285971895 | Timothy B Tabor Md PC | Radiology | 1701 Pelham Rd S, Jacksonville, AL 36265-3369 | 2013-01-16 |
| 1942506852 | Physician Services of Alabama LLC | Specialist | 1701 Pelham Rd S, Jacksonville, AL 36265-3369 | 2011-02-10 |
| 1285945832 | Wade Bilger | Nurse Anesthetist, Certified Registered | 1701 Pelham Rd S, Jacksonville, AL 36265-3369 | 2010-06-29 |
| 1023253762 | Jacksonville Emergency Physicians LLC | Emergency Medicine | 1701 Pelham Rd S, Jacksonville, AL 36265-3369 | 2008-12-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700436144 | Griffin Loflin | Specialist/Technologist | 775 Park Ave Nw, Attn. Sports Medicine, Jacksonville, AL 36265 | 2019-09-17 |
| 1114304011 | Caroline Ross | Counselor | 1215 Jackson Way Sw, Jacksonville, AL 36265 | 2015-04-29 |
| 1083001226 | Tracey Hudgins | Counselor | 1215 Jackson's Way, Jacksonville, AL 36265 | 2015-04-24 |
| 1235415118 | Adam Pike | Pharmacist | 311 Pelham Rd So, Jacksonville, AL 36265 | 2011-10-24 |
| 1386829489 | Physicians Choice Dialysis of Jacksonville, LLC | Clinic/Center | 331 Henry Road Sw, Jacksonville, AL 36265 | 2008-01-08 |
| 1659409365 | Kenneth Wayne Campbell | Nurse Anesthetist, Certified Registered | 1701 Pelham Road, Jacksonville Medical Center, Jacksonville, AL 36265 | 2007-03-02 |
| 1154478378 | Diana C. Ford | Counselor | 1250 Jackson's Way, Garrett Counseling Center, Jacksonville, AL 36265 | 2007-01-03 |
| 1487710950 | James Richard Morrison | Chiropractor | 1550 Pelham Rd. S., Jacksonville, AL 36265 | 2006-12-29 |
| 1447332937 | Millennium Anesthesia Services | Anesthesiology | 1701 Pelham Road S, Jacksonville, AL 36265 | 2006-10-20 |
| 1407943228 | Brunda Revanna, Md | Clinic/Center | 1465 A 1st Ave Sw Ste C, Jacksonville, AL 36265 | 2006-10-05 |
| Find all providers in zip 36265 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992275572 | William Lundgren | Nurse Anesthetist, Certified Registered | 3625 University Blvd South, Jacksonville, FL 32258 | 2018-11-27 |
| 1215436423 | Jenitre Shavonne Moore | Nurse Anesthetist, Certified Registered | 5885 Edenfield Rd Apt L32, Jacksonville, FL 32277-1203 | 2018-02-03 |
| 1811402407 | Aubrey Crowe | Nurse Anesthetist, Certified Registered | 1415 Windsor Pl, Jacksonville, FL 32205-7910 | 2017-12-05 |
| 1497294516 | Megan Powell | Nurse Anesthetist, Certified Registered | 13003 Springs Manor Dr, Jacksonville, FL 32258-8437 | 2017-02-22 |
| 1679017123 | Catherine Scanlon | Nurse Anesthetist, Certified Registered | 4635 Charles Bennett Dr, Jacksonville, FL 32225-1301 | 2016-12-16 |
| 1720444623 | Katrina Canady | Nurse Anesthetist, Certified Registered | 13609 Devan Lee Dr E, Jacksonville, FL 32226-5810 | 2016-01-07 |
| 1104291822 | Jenny Kambel | Nurse Anesthetist, Certified Registered | 13856 Herons Landing Way, Apt 5, Jacksonville, FL 32224-6065 | 2015-12-07 |
| 1609240746 | Matthew James Dailey | Nurse Anesthetist, Certified Registered | 2500 San Pablo Rd S, Jacksonville, FL 32224 | 2015-11-29 |
| 1437540234 | Catherine Simms | Nurse Anesthetist, Certified Registered | 400 Health Park Boulevard St., Jacksonville, FL 32086 | 2015-02-16 |
| 1699164889 | Valerie Wolff Aquino | Nurse Anesthetist, Certified Registered | 8638 Stanmoor Ct, Jacksonville, FL 32244-7160 | 2015-01-12 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 36265 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.