Provider Demographics
NPI:1992034607
Name:SUPERIOR ANESTHESIA SERVICES
Entity type:Organization
Organization Name:SUPERIOR ANESTHESIA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLUMREICH
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:501-227-0700
Mailing Address - Street 1:PO BOX 55990
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72215-5990
Mailing Address - Country:US
Mailing Address - Phone:501-227-0700
Mailing Address - Fax:
Practice Address - Street 1:4921 INVERNESS RUN DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-8061
Practice Address - Country:US
Practice Address - Phone:870-275-6037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC02705367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty