| Miss Tiffany Shannon Ray, CRNA | |
|
6410 Walnut Grove Rd, Horn Lake, MS 38637-2023 | |
| (901) 652-0880 | |
| Not Available |
| Full Name | Miss Tiffany Shannon Ray |
|---|---|
| Gender | Female |
| Speciality | Certified Registered Nurse Anesthetist (crna) |
| Experience | 9 Years |
| Location | 6410 Walnut Grove Rd, Horn Lake, Mississippi |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114097615 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 864509 (Mississippi) | Primary |
| 367500000X | Nurse Anesthetist, Certified Registered | 15099 (Tennessee) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Baptist Memorial Hospital | Memphis, TN | Hospital |
| Regional One Health | Memphis, TN | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Gastroenterology Center Of The Midsouth Pllc | 4880619824 | 155 |
| Midsouth Speciality Anesthesia Services Llc | 6103293667 | 22 |
| Mid-south Imaging And Therapeutics, P.a. | 9133106396 | 76 |
| Anesthesia Solutions Llc | 1557770096 | 8 |
| Gastroenterology Center Of The Midsouth Pllc | 4880619824 | 155 |
| Ut Regional One Physicians Inc | 5698993418 | 298 |
| Midsouth Speciality Anesthesia Services Llc | 6103293667 | 22 |
| Mid-south Imaging And Therapeutics, P.a. | 9133106396 | 76 |
| American Anesthesiology Of Tennessee Pc | 9931001922 | 282 |
| Entity Name | Gastroenterology Center Of The Midsouth Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1417932492 PECOS PAC ID: 4880619824 Enrollment ID: O20051010000483 |
| Entity Name | Willow Anesthesia Services, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1205169521 PECOS PAC ID: 9234279183 Enrollment ID: O20091228000308 |
| Entity Name | Poplar Avenue Clinic, Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1124588793 PECOS PAC ID: 0042552457 Enrollment ID: O20190506001682 |
| Entity Name | Soms Anesthesia, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1063010189 PECOS PAC ID: 9133531254 Enrollment ID: O20201215000881 |
| Entity Name | Midsouth Speciality Anesthesia Services Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1245956440 PECOS PAC ID: 6103293667 Enrollment ID: O20221114002027 |
| Mailing Address | Practice Location Address |
|---|---|
| Miss Tiffany Shannon Ray, CRNA One Gi Credentialing Department, Po Box 381468, Germantown, TN 38183-1468 Ph: () - | Miss Tiffany Shannon Ray, CRNA 6410 Walnut Grove Rd, Horn Lake, MS 38637-2023 Ph: (901) 652-0880 |