Provider Demographics
NPI:1114927738
Name:AMERICAN ANESTHESIOLOGY GROUP OF TENNESSEE, P. C.
Entity Type:Organization
Organization Name:AMERICAN ANESTHESIOLOGY GROUP OF TENNESSEE, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-224-3460
Mailing Address - Street 1:135 W RAVINE RD STE 5-B
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3847
Mailing Address - Country:US
Mailing Address - Phone:423-224-3460
Mailing Address - Fax:423-224-3465
Practice Address - Street 1:135 W RAVINE RD
Practice Address - Street 2:STE 5-B
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3847
Practice Address - Country:US
Practice Address - Phone:423-224-3460
Practice Address - Fax:423-224-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
373565800OtherUS DEPT OF LABOR-OWCP
1374528OtherAAG BENEFIT PLAN ADMIN
TN3701197Medicaid
NC89020PMedicaid
CB1389OtherRAILROAD MEDICARE
KY7490409500OtherMEDICAID
CB1389OtherRAILROAD MEDICARE
TN3623538OtherMEDICAID
373565800OtherUS DEPT OF LABOR-OWCP
CB1389OtherRAILROAD MEDICARE
WV381001862Medicaid