| 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 | 10 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 |
| 200020616 | Medicaid | MS | |
| Q057613 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 15099 (Tennessee) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | 864509 (Mississippi) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Baptist Memorial Hospital | Memphis, TN | Hospital |
| Methodist Healthcare Memphis Hospitals | Memphis, TN | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Resource Anesthesiology Associates Of Tn Pc | 8527419092 | 150 |
| Midsouth Speciality Anesthesia Services Llc | 6103293667 | 29 |
| Midsouth Speciality Anesthesia Services Llc | 6103293667 | 29 |
| American Anesthesiology Of Tennessee Pc | 9931001922 | 310 |
| Mid-south Imaging And Therapeutics, P.a. | 9133106396 | 69 |
| Anesthesia Solutions Llc | 1557770096 | 8 |
| Mid-south Imaging And Therapeutics, P.a. | 9133106396 | 69 |
| Gastroenterology Center Of The Midsouth Pllc | 4880619824 | 152 |
| Entity Name | Mid-south Imaging & Therapeutics, P.a. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1043260763 PECOS PAC ID: 9133106396 Enrollment ID: O20040706000767 |
| Entity Name | American Anesthesiology Of Tennessee Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1609822998 PECOS PAC ID: 9931001922 Enrollment ID: O20040713001364 |
| 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: O20060201000753 |
| Entity Name | Ut Regional One Physicians Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1093130585 PECOS PAC ID: 5698993418 Enrollment ID: O20140820000662 |
| Entity Name | Anesthesia Solutions Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1639758535 PECOS PAC ID: 1557770096 Enrollment ID: O20210512002686 |
| 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: O20221121000130 |
| Entity Name | Mid-south Vascular Physicians Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1073360061 PECOS PAC ID: 0840732483 Enrollment ID: O20240611000769 |
| Mailing Address | Practice Location Address |
|---|---|
| Miss Tiffany Shannon Ray, CRNA 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 |