| Jason Tibbett, CRNA | |
|
200 Tyler St, West Memphis, AR 72301 | |
| (870) 735-1500 | |
| (870) 733-3861 |
| Full Name | Jason Tibbett |
|---|---|
| Gender | Male |
| Speciality | Certified Registered Nurse Anesthetist (crna) |
| Experience | 15 Years |
| Location | 200 Tyler St, West Memphis, Arkansas |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790084028 | NPI | - | NPPES |
| 169954 | Other | TN LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | AP07594 (Louisiana) | Primary |
| 367500000X | Nurse Anesthetist, Certified Registered | 169954 (Tennessee) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Specialists Hospital Shreveport | Shreveport, LA | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Novus Louisiana Medical Professional Corporation | 5395194880 | 21 |
| Entity Name | Mid-louisiana Anesthesia Consultants, Apmc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1205888914 PECOS PAC ID: 3971408733 Enrollment ID: O20031204000583 |
| Entity Name | Natchitoches Anesthesia Associates Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1992827182 PECOS PAC ID: 4981591088 Enrollment ID: O20040303000373 |
| Entity Name | Medical Center Anesthesiologists |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1669469748 PECOS PAC ID: 6608814843 Enrollment ID: O20050419001114 |
| Entity Name | Novus Louisiana Medical Professional Corporation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1336926872 PECOS PAC ID: 5395194880 Enrollment ID: O20231208002673 |
| Mailing Address | Practice Location Address |
|---|---|
| Jason Tibbett, CRNA Po Box 5887, Alexandria, LA 71307-5887 Ph: (870) 735-1500 | Jason Tibbett, CRNA 200 Tyler St, West Memphis, AR 72301 Ph: (870) 735-1500 |
Mr. Tommy Lee Fair, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 200 W Tyler Ave, West Memphis, AR 72301 Phone: 870-735-1500 Fax: 870-733-3861 |