Organization
SOUTHCREST ANESTHESIA GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBBIE BREWER (DIRECTOR PROVIDER ENROLLMENT)
(615) 465-1626
Entity
Organization
Contact information
Practice address
8801 S 101ST EAST AVE, TULSA, OK 74133-5716
(918) 294-4803
Mailing address
7100 COMMERCE WAY, SUITE 180, BRENTWOOD, TN 37027-2829
(615) 465-7626
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200085890A
—
OK
Enumeration date
05/20/2006
Last updated
08/06/2009
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