Colquitt Regional Anesthesia, LLC
Organization Active NPI Specialist · Moultrie, GA
NPI 1154580512 · NPPES record last updated Jun 2, 2008
Key facts
- NPI
- 1154580512
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- Legal business name
- COLQUITT REGIONAL ANESTHESIA, LLC
- Practice address
- 3131 S Main St
Moultrie, GA 31768-6925 - Phone
- (229) 985-3420
- Fax
- (229) 891-9079
- NPI assigned
- Jun 2, 2008
- Organization subpart
- No
Authorized official
- Name
- Judy B Ricks
- Title
- Provider Enrollment Coordinator
- Phone
- (229) 891-9131
Practitioners 34
-
Travis Lee Bailey, D.O.
-
Daniel L Dell, CRNA
-
Ellis R Jackson, CRNA
-
Cori Norman, CRNA
-
Jeffrey W Roberts, CRNA
-
Brian Scott Vickery, CRNA
-
Marcus Antonio Walton, M.D.
-
Curtis Winfred Wilson, C.R.N.A.
-
Robert Kent Cales, CRNA
-
Katrina Canady, A.R.N.P., C.R.N.A
-
Kelsi Leonard, CRNA
-
Merida Caleb Logan, CRNA
-
Ikram Malik, M.D.
-
Mary M Thorsson, CRNA
-
Tracy Dale Stanley, CRNA
-
Kimberly Michelle Powell, PA-C
-
James B. Hough, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080623000359 | GA | Part B Supplier - Clinic/Group Practice | 2860563665 |
Receives reassigned benefits from 25 practitioners Practice locations: Moultrie, GA |
National Provider Directory
Locations
3131 S Main St
#1358
Moultrie, GA 31768
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | Yes |
Addresses
Primary practice location
3131 S Main St
Moultrie, GA 31768-6925
Mailing address
PO Box 3305
Moultrie, GA 31776-3305
Phone (229) 985-3420
Other providers in Moultrie, GA
- Colquitt County Hospital Authority
- Colquitt Emergency Group LLC
- Colquitt Family Care, Inc.
- Colquitt Optical House
- Colquitt Pathology PC
- Colquitt Regional Cardiology, LLC
- Colquitt Regional Dermatology, LLC
- Colquitt Regional Ear Nose & Throat
- Colquitt Regional Emergency Physicians, LLC
- Colquitt Regional Gastroenterology, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 2, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.