Ambulatory Surgery Anesthesia LLC
Organization Active NPI Certified Registered Nurse Anesthetist · Lawrenceville, GA
NPI 1336328293 · NPPES record last updated Oct 30, 2007
Key facts
- NPI
- 1336328293
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- Legal business name
- AMBULATORY SURGERY ANESTHESIA LLC
- Practice address
- 475 Philip Blvd
Suite 304
Lawrenceville, GA 30045-8737 - Phone
- (678) 377-8252
- NPI assigned
- Oct 29, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Bhuvanendram Indrakrishnan, MD
- Title
- Sole Member
- Phone
- (678) 377-8252
Practitioners 7
-
Kerry H Metcalf, CRNA
-
Joshua Scott Newby, CRNA
-
Morisson Jacquitte, M.D
-
Lance M Johnson, CRNA
-
Jay Coleman Watson, CRNA
-
Daniel Eldridge McAlvin, CRNA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080107000599 | GA | Part B Supplier - Clinic/Group Practice | 8426138256 |
Receives reassigned benefits from 6 practitioners Practice locations: Lawrenceville, GA |
National Provider Directory
Locations
475 Philip Blvd
Ste 304
Lawrenceville, GA 30046
Phone (678) 377-8252
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist |
367500000X | Yes |
Addresses
Primary practice location
475 Philip Blvd
Suite 304
Lawrenceville, GA 30045-8737
Mailing address
PO Box 8846
Greensboro, NC 27419-0846
Phone (336) 553-1659
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All providers in Lawrenceville, GA · Certified Registered Nurse Anesthetist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2007. 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.