Organization
DEEP SOUTH ANESTHESIA, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON TODD LANE CRNA (CRNA/OWNER)
(800) 204-0099
Entity
Organization
Contact information
Practice address
801 GOODYEAR BLVD, PICAYUNE, MS 39466-3221
(601) 798-4711
Mailing address
200 LONGSTREET LN, PICAYUNE, MS 39466-4413
(800) 204-0099
(336) 882-2216
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
08/20/2010
Last updated
08/20/2010
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