Southeast Mobile Anesthesia LLC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

40009 Issued in KY

Legal business name

SOUTHEAST MOBILE ANESTHESIA LLC

Practice address

1727 Coachtrail Dr
Hebron, KY 41048-8476

Phone

(859) 409-2022

Fax

(513) 332-9225

NPI assigned

Mar 26, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark Jackson, MD

Title

President

Phone

(859) 409-2022

Specialties & licenses 1

Addresses

Other identifiers 4

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1269561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269561600000",
    "number": "1033433503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1727 COACHTRAIL DR",
            "city": "HEBRON",
            "state": "KY",
            "postal_code": "410488476",
            "telephone_number": "859-409-2022",
            "fax_number": "513-332-9225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1727 COACHTRAIL DR",
            "city": "HEBRON",
            "state": "KY",
            "postal_code": "410488476",
            "telephone_number": "859-409-2022",
            "fax_number": "513-332-9225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST MOBILE ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-26",
        "last_updated": "2010-03-26",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "859-409-2022",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "KY",
            "license": "40009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000566553",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200902520",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100042320",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "28720930",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edward Blake Schumann, PT, DPT
• Rebecca Len Scott, PHARMD
• Adam Shiplett
• Joshua Kelly Slusher, DO
• Rachel Elizabeth Smithson, LCSW
• David Michael Stamper, PA-C
• Cheryl Stebbins
• David Stepner, PT
• Cynthia Elizabeth Stewart, MA
• James J Stewart Jr., MD

• Anesthesiology Physician in Hebron, KY
• Providers in Hebron, KY by specialty
• Anesthesiology Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.