NPIMap

Organization Active NPI

Colquitt Regional Anesthesia, LLC

  • Specialist
  • Moultrie, GA
National Provider Identifier
1154580512
Registry record updated Jun 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 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
Last updated
Jun 2, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2008

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

Authorized official

Name
Judy B Ricks
Title
Provider Enrollment Coordinator
Phone
(229) 891-9131

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080623000359 GA Part B Supplier - Clinic/Group Practice 2860563665 Receives reassigned benefits from 25 practitioners
Practice locations: Moultrie, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1212364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212364800000",
    "number": "1154580512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3305",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317763305",
            "telephone_number": "229-985-3420",
            "fax_number": "229-891-9079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3131 S MAIN ST",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686925",
            "telephone_number": "229-985-3420",
            "fax_number": "229-891-9079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLQUITT REGIONAL ANESTHESIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-02",
        "last_updated": "2008-06-02",
        "status": "A",
        "authorized_official_last_name": "RICKS",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT COORDINATOR",
        "authorized_official_telephone_number": "229-891-9131"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moultrie, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.