Provider Demographics
NPI:1346390937
Name:EAST TENNESSEE ANESTHESIA SERVICES. LLC
Entity Type:Organization
Organization Name:EAST TENNESSEE ANESTHESIA SERVICES. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TEMPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-676-6600
Mailing Address - Street 1:221 SHADOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-1128
Mailing Address - Country:US
Mailing Address - Phone:423-676-6600
Mailing Address - Fax:
Practice Address - Street 1:221 SHADOWOOD DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-1128
Practice Address - Country:US
Practice Address - Phone:423-676-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3870369Medicare ID - Type Unspecified