# SOUTHEAST MOBILE ANESTHESIA LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033433503
- **Authorized official:** DR. MARK JACKSON MD (PRESIDENT)
- **Authorized official phone:** (859) 409-2022

## Contact information

- **Practice address:** 1727 COACHTRAIL DR, HEBRON, KY 41048-8476
- **Practice address phone:** (859) 409-2022
- **Practice address fax:** (513) 332-9225
- **Mailing address:** 1727 COACHTRAIL DR, HEBRON, KY 41048-8476
- **Mailing address phone:** (859) 409-2022
- **Mailing address fax:** (513) 332-9225

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | 40009 | KY | Yes |

## Other

- **Enumeration date:** 03/26/2010
- **Last updated:** 03/26/2010