Provider Demographics
NPI:1033162045
Name:RESOURCE ANESTHESIA, P.C.
Entity Type:Organization
Organization Name:RESOURCE ANESTHESIA, P.C.
Other - Org Name:LOUDON ANESTHESIA ASSOCIATES, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:HAYNIE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN-CRNA, MBA
Authorized Official - Phone:865-777-0909
Mailing Address - Street 1:12752 KINGSTON PIKE
Mailing Address - Street 2:STE E202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-0948
Mailing Address - Country:US
Mailing Address - Phone:865-777-0909
Mailing Address - Fax:865-777-0910
Practice Address - Street 1:550 FORT LOUDOUN MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5673
Practice Address - Country:US
Practice Address - Phone:865-271-6000
Practice Address - Fax:865-777-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY323889OtherBLUE CROSS/BLUE SHIELD
KY74900648Medicaid
KY000000267221OtherANTHEM BCBS KY
TN4022215OtherBLUE CROSS/BLUE SHIELD
TN3630129Medicaid
AZ536581Medicaid
KYDD8474OtherRAILROAD MEDICARE
OK200200040AMedicaid
TNCJ4420OtherRAILROAD MEDICARE
OKDN3970OtherRAILROAD MEDICARE
KY74900648Medicaid
OKDN3970OtherRAILROAD MEDICARE
KY9073Medicare PIN
TN4022215OtherBLUE CROSS/BLUE SHIELD
OK=========0001OtherBLUE CROSS/BLUE SHIELD