Provider Demographics
NPI:1477958189
Name:AMSURG MELBOURNE ANESTHESIA LLC
Entity Type:Organization
Organization Name:AMSURG MELBOURNE ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIRECTOR OF RCM TRANSFORMATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOCHENDORFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-263-4012
Mailing Address - Street 1:1A BURTON HILLS BLVD
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6187
Mailing Address - Country:US
Mailing Address - Phone:615-240-3809
Mailing Address - Fax:615-234-1809
Practice Address - Street 1:1401 S APOLLO BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3179
Practice Address - Country:US
Practice Address - Phone:321-725-5151
Practice Address - Fax:321-725-5157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty