Provider Demographics
NPI:1487929121
Name:MID-SOUTH ANESTHESIA, PLLC
Entity type:Organization
Organization Name:MID-SOUTH ANESTHESIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:859-200-3083
Mailing Address - Street 1:2901 RICHMOND RD
Mailing Address - Street 2:SUITE 130 PMB 302
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1771
Mailing Address - Country:US
Mailing Address - Phone:859-200-3083
Mailing Address - Fax:
Practice Address - Street 1:2901 RICHMOND RD
Practice Address - Street 2:SUITE 130 PMB 302
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1771
Practice Address - Country:US
Practice Address - Phone:859-200-3083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty