Provider Demographics
NPI:1124415567
Name:NORTHSTAR ANESTHESIA OF MISSISSIPPI, LLC
Entity type:Organization
Organization Name:NORTHSTAR ANESTHESIA OF MISSISSIPPI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUMBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-687-0001
Mailing Address - Street 1:PO BOX 610506
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75261-0506
Mailing Address - Country:US
Mailing Address - Phone:239-610-0775
Mailing Address - Fax:
Practice Address - Street 1:54 SERGEANT PRENTISS DR
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4726
Practice Address - Country:US
Practice Address - Phone:601-443-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty