Provider Demographics
NPI:1922838523
Name:ETHERCO ANESTHESIA PLLC
Entity type:Organization
Organization Name:ETHERCO ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUMPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:501-366-1907
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:501-227-0744
Practice Address - Street 1:7005 S HAZEL ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7833
Practice Address - Country:US
Practice Address - Phone:501-227-7000
Practice Address - Fax:501-227-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty