Provider Demographics
NPI:1548565245
Name:MID SOUTH ANESTHESIA PC
Entity Type:Organization
Organization Name:MID SOUTH ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:SR
Authorized Official - Credentials:CRNA, MS, APN
Authorized Official - Phone:615-444-2320
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37088-5000
Mailing Address - Country:US
Mailing Address - Phone:615-444-2320
Mailing Address - Fax:615-547-9845
Practice Address - Street 1:322 22ND AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1842
Practice Address - Country:US
Practice Address - Phone:615-444-2320
Practice Address - Fax:615-547-9845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNR0000058326367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty