Organization
JACKSONVILLE ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROB CLEMENS MD PHD (CEO)
(660) 826-5960
Entity
Organization
Contact information
Practice address
1701 PELHAM RD S, JACKSONVILLE, AL 36265-3369
(256) 435-4970
Mailing address
PO BOX 1547, SEDALIA, MO 65302-1547
(660) 826-5960
(660) 826-4852
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
12/08/2009
Last updated
12/08/2009
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