Provider Demographics
NPI:1053358937
Name:LAKELAND ANESTHESIA, PLLC
Entity type:Organization
Organization Name:LAKELAND ANESTHESIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STALLINGS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:601-936-0681
Mailing Address - Street 1:3010 LAKELAND CV
Mailing Address - Street 2:SUITE J
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9784
Mailing Address - Country:US
Mailing Address - Phone:601-936-0681
Mailing Address - Fax:601-936-0686
Practice Address - Street 1:1026 N FLOWOOD DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9532
Practice Address - Country:US
Practice Address - Phone:601-936-0681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014262Medicaid
CC3482OtherMEDICARE RAILROAD
MS09014262Medicaid