WILLOW ANESTHESIA SERVICES, LLC (NPI# 1205169521) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205169521 |
| Entity Type | Organization |
| Organization Name | WILLOW ANESTHESIA SERVICES, LLC |
| Practice Address |
2704 W Oxford Loop Suite 117 Oxford MS 38655-5714 |
| Practice Telephone | 6625504299 |
| Practice Fax Number | 6625804324 |
| Mailing Telephone | 6625504299 |
| Mailing Fax Number | 6625804324 |
| Enumeration Date | 2009-09-18 |
| Last Update Date | 2019-07-11 |
| Authorized Official Name | DAVID GARRETT MCCULLEN (MEMBER) |
| Authorized Official Telephone | 6625504299 |
| Authorized Official Credential | CRNA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 02537897 | 05 | |
| RR MEDICARE | DP9729 | 01 |
| Street Address |
2704 W OXFORD LOOP SUITE 117 |
| City | OXFORD |
| State | MS |
| Zip Code | 38655-5714 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205441979 | Andrew Paul Bundt | Registered Nurse | 2704 W Oxford Loop, Oxford, MS 38655-5723 | 2020-09-10 |
| 1932576550 | Charles Ezelle | Nurse Anesthetist, Certified Registered | 2704 W Oxford Loop, Suite 117, Oxford, MS 38655-5714 | 2015-08-31 |
| 1689019929 | John David Maharrey | Registered Nurse | 2704 W Oxford Loop, Suite 117, Oxford, MS 38655-5714 | 2013-04-30 |
| 1861789240 | Julie A Hammond | Nurse Anesthetist, Certified Registered | 2704 W Oxford Loop, Suite 117, Oxford, MS 38655-5714 | 2011-07-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619585809 | Oxford Treatment Center, LLC | Substance Abuse Rehabilitation Facility | 616 Commerce Parkway, Oxford, MS 38655 | 2020-07-14 |
| 1760044465 | Lindsay Low Beauchamp | Speech-Language Pathologist | 169 Ms-6 #102, Oxford, MS 38655 | 2019-07-02 |
| 1861058075 | Tomiko D Mackey | Social Worker | 100 Carriage Cove, Oxford, MS 38655 | 2019-05-13 |
| 1174090039 | Derionne Brooks | Specialist/Technologist | 972 Hathorn Road, University, MS 38655 | 2018-10-30 |
| 1497236327 | Providence Companion Care | Nurse's Aide | 317 Heritage Dr Ste 3b, Oxford, MS 38655 | 2018-08-28 |
| 1255817292 | Marcela Caroline Weber | Counselor | 152 Mississippi 7 South, Oxford, MS 38655 | 2018-07-12 |
| 1649775123 | Oxford Outpatient Center, LLC | Clinic/Center | 611 Commerce Pkwy, Oxford, MS 38655 | 2018-03-27 |
| 1073039962 | Sharon Yvette Holloway | Social Worker | 152 Hwy and South, Oxford, Ms 38655, Oxford, MS 38655 | 2017-08-22 |
| 1447774682 | Courtney M Purvis | Physical Therapist | 300 Enterprise Dr Ste B, Oxford, MS 38655 | 2017-07-31 |
| 1649716580 | Taylor Lynn Smith | Counselor | 152 Ms-7, Oxford, MS 38655 | 2017-01-17 |
| Find all providers in zip 38655 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063873438 | Holder Anesthesia | Nurse Anesthetist, Certified Registered | 2311 Jackson Ave W, Suite 302, Oxford, MS 38655-5750 | 2016-03-14 |
| 1134567761 | Lori Gray | Nurse Anesthetist, Certified Registered | 2704 W Oxford Loop Ste 117, Oxford, MS 38655 | 2013-06-05 |
| 1548405780 | Contessa Ward Fields | Nurse Anesthetist, Certified Registered | 2301south Lamar, Oxford, MS 38655 | 2008-12-02 |
| 1043259146 | Clifford Blaylock | Nurse Anesthetist, Certified Registered | 208 Rachelle Dr, Oxford, MS 38655-6135 | 2006-06-05 |
| 1609825959 | Jeffrey D Smith | Nurse Anesthetist, Certified Registered | 1440 Highway Dr, Oxford, AL 36203-1951 | 2006-05-06 |
| 1063492023 | Penneye Holder | Nurse Anesthetist, Certified Registered | 1208 Office Park Dr, Oxford, MS 38655-3597 | 2006-01-18 |
| 1972598415 | Richard D Sutherlin IIi | Nurse Anesthetist, Certified Registered | 518 College Hill Rd, Oxford, MS 38655-2026 | 2005-09-12 |
| 1093348351 | Oxford Anesthesia Group | Nurse Anesthetist, Certified Registered | 497 Azalea Dr Ste 101, Oxford, MS 38655-7907 | 2020-02-14 |
| 1962046151 | Solace Anesthesia, LLC | Nurse Anesthetist, Certified Registered | 12117 Cr 103, Oxford, FL 34484 | 2019-10-31 |
| 1932576550 | Charles Ezelle | Nurse Anesthetist, Certified Registered | 2704 W Oxford Loop, Suite 117, Oxford, MS 38655-5714 | 2015-08-31 |
| Find all providers in OXFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.