Provider Demographics
NPI:1376865857
Name:T E ANESTHESIA LLC
Entity Type:Organization
Organization Name:T E ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:T
Authorized Official - Last Name:EDALGO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:478-257-6923
Mailing Address - Street 1:220 PROVIDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-7551
Mailing Address - Country:US
Mailing Address - Phone:478-257-6923
Mailing Address - Fax:
Practice Address - Street 1:1854 FORSYTH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1169
Practice Address - Country:US
Practice Address - Phone:478-257-6923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty