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Organization

PERFORMANCE ANESTHESIA INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RANDALL J WILSON (OWNER)
(205) 979-5882
Entity
Organization

Contact information

Practice address
202 HOSPITAL ST, MOULTON, AL 35650-1218
(256) 974-2200
(256) 216-1982
Mailing address
PO BOX 660257, BIRMINGHAM, AL 35266-0257
(205) 979-5882
(205) 979-1248

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary

Other

Enumeration date
09/05/2012
Last updated
09/05/2012
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