Provider Demographics
NPI:1235254525
Name:SYCAMORE SHOALS ANESTHESIA ASSOCIATES PC
Entity Type:Organization
Organization Name:SYCAMORE SHOALS ANESTHESIA ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER BD SECY
Authorized Official - Prefix:MRS
Authorized Official - First Name:NYOKA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-542-2738
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37644-0040
Mailing Address - Country:US
Mailing Address - Phone:423-542-2738
Mailing Address - Fax:423-542-2738
Practice Address - Street 1:922 WEST G STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2935
Practice Address - Country:US
Practice Address - Phone:423-542-2738
Practice Address - Fax:423-542-2738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3703755Medicaid
TN3703755Medicare ID - Type Unspecified