Organization
MID-SOUTH ANESTHESIA CONSULTANTS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRIE L. CARLETON (ACCOUNT MANAGER)
(334) 386-2053
Entity
Organization
Contact information
Practice address
7601 SOUTHCREST PKWY, SOUTHAVEN, MS 38671-4739
(334) 386-2053
(334) 244-1830
Mailing address
PO BOX 235022, MONTGOMERY, AL 36123-5022
(334) 386-2053
(334) 244-1830
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015515
—
MS
01
—
CB3549
RAILROAD MEDICARE GRP #
MS
Enumeration date
05/18/2006
Last updated
10/09/2008
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