MISSISSIPPI ANESTHESIA GROUP, LLC (NPI# 1366845554) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366845554 |
| Entity Type | Organization |
| Organization Name | MISSISSIPPI ANESTHESIA GROUP, LLC |
| Practice Address |
145 Sanctuary Ln Canton MS 39046-6601 |
| Mailing Address |
2714 W Oxford Loop Ste 161 Oxford MS 38655-5711 |
| Practice Telephone | 6018557440 |
| Mailing Telephone | 6625504299 |
| Mailing Fax Number | 6625804324 |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2014-10-01 |
| Authorized Official Name | GARY DWAYNE SELF (FOUNDER AND PRESIDENT) |
| Authorized Official Telephone | 6016685628 |
| Authorized Official Credential | CRNA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | R598755 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
145 SANCTUARY LN |
| City | CANTON |
| State | MS |
| Zip Code | 39046-6601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043858053 | Pediatric Haven | Skilled Nursing Facility | 112 Westfalen Drive, Canton, MS 39046 | 2019-12-20 |
| 1932743176 | Stacey Elizabeth Aldridge | Social Worker | 210 E Peace Street, Canton, MS 39046 | 2019-10-31 |
| 1881245736 | Mildred Loving | Technician | 323 Shady Lane, Canton, MS 39046 | 2019-09-23 |
| 1295384683 | Betty Bass | Technician | 693 Miggins Road, Canton, MS 39046 | 2019-09-09 |
| 1972081644 | Charles Brayden Jones | Physical Therapist | 276 Nissan Pkwy Ste 400, Canton, MS 39046 | 2018-08-03 |
| 1013436062 | Andrew J Breland | Counselor | 210 E Peace St, Canton, MS 39046 | 2017-09-11 |
| 1801318290 | Mississippi Enjoy Breastfeeding Shalom Resource Center | Clinic/Center | 343 Smith Street, Canton, MS 39046 | 2017-07-07 |
| 1619362977 | Shameca Hudson | Nurse Practitioner | 274 Cobbville Dr E, Canton, MS 39046 | 2015-04-03 |
| 1144644386 | Margaret Reimers Beckwith | Chiropractor | 124 Links Drive, I-103, Canton, MS 39046 | 2014-02-07 |
| 1053753194 | Tanya Linette Calhoun | Nurse Practitioner | 1171 Hart Street, Canton, MS 39046 | 2013-07-17 |
| Find all providers in zip 39046 | ||||
| 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 |
|---|---|---|---|---|
| 1396264040 | Brandi Hanchosky | Nurse Anesthetist, Certified Registered | 4665 Douglas Cir Nw # 100, Canton, OH 44718-3673 | 2017-09-13 |
| 1952841637 | Andrew Joseph Proctor | Nurse Anesthetist, Certified Registered | 800 Pheasant Woods Drive, Canton, MI 48188-5224 | 2017-03-01 |
| 1083166383 | Khushbu Modi | Nurse Anesthetist, Certified Registered | 276 Harmony Lake Dr, Canton, GA 30115-4781 | 2016-11-03 |
| 1760930572 | Branden Joaquin Sibley | Nurse Anesthetist, Certified Registered | 6889 Wales Crossing St Nw Apt D, Canton, OH 44720-5383 | 2016-09-21 |
| 1104236884 | Anne Elizabeth Murray | Nurse Anesthetist, Certified Registered | 173 Dedham St, Canton, MA 02021-1560 | 2014-05-02 |
| 1952593865 | Brett T King | Nurse Anesthetist, Certified Registered | 208 Towne Overlook Dr, Canton, GA 30114-7239 | 2007-08-14 |
| 1184767436 | Sed 8 Inc. | Nurse Anesthetist, Certified Registered | 1017 Field St Nw, Canton, OH 44709-1635 | 2007-02-15 |
| 1144246190 | Elfrieda Marie Londeree | Nurse Anesthetist, Certified Registered | Ohio Hospital Based Physician Corp, 2600 Sixth Street Sw, Canton, OH 44710 | 2006-07-14 |
| 1528010675 | Brian K Norcia | Nurse Anesthetist, Certified Registered | 4665 Douglas Cir Nw Ste 100, Canton, OH 44718-3673 | 2006-05-17 |
| 1750342366 | Ramon Luis Medina | Nurse Anesthetist, Certified Registered | 125 Woodbury Ln, Canton, GA 30114-4590 | 2006-03-31 |
| Find all providers in CANTON | ||||
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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.