Provider Demographics
NPI:1285100594
Name:JMJ ANESTHESIA PC
Entity type:Organization
Organization Name:JMJ ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:615-428-1594
Mailing Address - Street 1:544 COUNTY ROAD 176
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-5767
Mailing Address - Country:US
Mailing Address - Phone:615-428-1594
Mailing Address - Fax:
Practice Address - Street 1:15155 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1975
Practice Address - Country:US
Practice Address - Phone:256-332-1611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL20181173OtherANESTHESIA