NPIMap

Organization Active NPI

Mississippi Anesthesia Group, LLC

  • Certified Registered Nurse Anesthetist
  • Canton, MS
National Provider Identifier
1366845554
Registry record updated Oct 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R598755 Issued in MS
Legal business name
MISSISSIPPI ANESTHESIA GROUP, LLC
Practice address
145 Sanctuary LN
Canton, MS 39046-6601
Phone
(601) 855-7440
NPI assigned
Oct 1, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2014

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

Authorized official

Name
Gary Dwayne Self, CRNA
Title
Founder and President
Phone
(601) 668-5628

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X R598755 MS Primary

Addresses

Primary practice location

145 Sanctuary LN
Canton, MS 39046-6601

Mailing address

2714 W Oxford Loop
Ste 161
Oxford, MS 38655-5711
Phone (662) 550-4299

National Provider Directory

National Provider Directory

Locations

2714 West Oxford Loop
Ste 161
Oxford, MS 38655

NPI Registry JSON

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

{
    "created_epoch": "1412121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412121600000",
    "number": "1366845554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2714 W OXFORD LOOP",
            "address_2": "STE 161",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386555711",
            "telephone_number": "662-550-4299",
            "fax_number": "662-580-4324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 SANCTUARY LN",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390466601",
            "telephone_number": "601-855-7440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI ANESTHESIA GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-01",
        "last_updated": "2014-10-01",
        "status": "A",
        "authorized_official_last_name": "SELF",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "DWAYNE",
        "authorized_official_title_or_position": "FOUNDER AND PRESIDENT",
        "authorized_official_telephone_number": "601-668-5628",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "R598755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2014; 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.