Provider Demographics
NPI:1063873438
Name:HOLDER ANESTHESIA
Entity type:Organization
Organization Name:HOLDER ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PENNEYE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:662-550-4299
Mailing Address - Street 1:PO BOX 1596
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-1596
Mailing Address - Country:US
Mailing Address - Phone:662-550-4299
Mailing Address - Fax:662-580-4324
Practice Address - Street 1:2311 JACKSON AVE W
Practice Address - Street 2:SUITE 302
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5750
Practice Address - Country:US
Practice Address - Phone:662-612-0063
Practice Address - Fax:662-580-4324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty