Organization
SOUTHCREST ANESTHESIA SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT LAWRENCE RYAN CRNA (OWNER PRACTICE MANAGER)
(662) 349-9136
Entity
Organization
Contact information
Practice address
7580 CLARINGTON CV, SOUTHAVEN, MS 38671-5657
(662) 349-9136
(662) 349-0677
Mailing address
PO BOX 1430, SOUTHAVEN, MS 38671-0015
(662) 349-9136
(662) 349-0677
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R691259
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015237
—
MS
Enumeration date
09/02/2006
Last updated
04/20/2008
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