Provider Demographics
NPI:1447202452
Name:TENNESSEE VALLEY ANESTHESIA PLLC
Entity Type:Organization
Organization Name:TENNESSEE VALLEY ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FAHEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:423-618-3448
Mailing Address - Street 1:5483 W WATERS AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1236
Mailing Address - Country:US
Mailing Address - Phone:813-287-5718
Mailing Address - Fax:813-287-5728
Practice Address - Street 1:105 N MEADOWS DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-4172
Practice Address - Country:US
Practice Address - Phone:423-649-3330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDD2592OtherRAILROAD MEDICARE GROUP
TN3729421Medicaid
TN3729421Medicare PIN