Provider Demographics
NPI:1124496906
Name:SOVA ANESTHESIA, PLLC
Entity type:Organization
Organization Name:SOVA ANESTHESIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:901-831-0930
Mailing Address - Street 1:2734 LIZZIE CV
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-7510
Mailing Address - Country:US
Mailing Address - Phone:901-831-0930
Mailing Address - Fax:
Practice Address - Street 1:2734 LIZZIE CV
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-7510
Practice Address - Country:US
Practice Address - Phone:901-831-0930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty