Organization
GULF ANESTHESIA SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN BLAKE BENEFIELD CRNA (MANAGER)
(228) 860-0820
Entity
Organization
Contact information
Practice address
12504 WINDANCE DR, GULFPORT, MS 39503-7780
(228) 860-0820
(228) 731-3446
Mailing address
PO BOX 24023, DEPT 03-084, JACKSON, MS 39225-4023
(228) 860-0820
(228) 731-3446
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
R863937
MS
367500000X
Certified Registered Nurse Anesthetist
R867945
MS
367500000X
Certified Registered Nurse Anesthetist
Primary
R874062
MS
Other
Enumeration date
09/17/2013
Last updated
10/11/2016
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