Provider Demographics
NPI:1750300836
Name:ANESTHESIA CONSULTANTS PA
Entity type:Organization
Organization Name:ANESTHESIA CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:W
Authorized Official - Last Name:PICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-933-9521
Mailing Address - Street 1:2550 FLOWOOD DRIVE
Mailing Address - Street 2:STE 400
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232
Mailing Address - Country:US
Mailing Address - Phone:601-933-9521
Mailing Address - Fax:601-933-9525
Practice Address - Street 1:1030 RIVER OAKS DR
Practice Address - Street 2:RIVER OAKS HEALTH SYSTEM
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39208
Practice Address - Country:US
Practice Address - Phone:601-932-1030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS208VP0000X, 367500000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02200Medicare PIN