Jacksonville Anesthesia LLC

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

Legal business name

JACKSONVILLE ANESTHESIA LLC

Practice address

1701 Pelham Rd S
Jacksonville, AL 36265-3369

Phone

(256) 435-4970

NPI assigned

Dec 8, 2009

Last updated

Dec 8, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Rob Clemens, MD PHD

Title

Ceo

Phone

(660) 826-5960

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1260230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260230400000",
    "number": "1205165065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1547",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653021547",
            "telephone_number": "660-826-5960",
            "fax_number": "660-826-4852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 PELHAM RD S",
            "city": "JACKSONVILLE",
            "state": "AL",
            "postal_code": "362653369",
            "telephone_number": "256-435-4970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-08",
        "last_updated": "2009-12-08",
        "status": "A",
        "authorized_official_last_name": "CLEMENS",
        "authorized_official_first_name": "ROB",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "660-826-5960",
        "authorized_official_credential": "MD PHD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracey Hudgins, LPC
• Brian Russell Ingram, DO
• Chandler Austin Ingram
• Megan Ingram, PHARM D
• Russell Leon Ingram, M.D.
• Jacksonville Aristo ER, LLC
• Jacksonville City
• Jacksonville Emergency Physicians LLC
• Jacksonville Health and Rehabilitation, LLC
• Jacksonville Internal Medicine

• Certified Registered Nurse Anesthetist in Jacksonville, AL
• Providers in Jacksonville, AL by specialty
• Certified Registered Nurse Anesthetist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2009; 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.