Provider Demographics
NPI:1578163770
Name:SOUTHEAST ANESTHESIA, PLC
Entity Type:Organization
Organization Name:SOUTHEAST ANESTHESIA, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:DEMAREE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:615-865-5561
Mailing Address - Street 1:PO BOX 293151
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37229-3151
Mailing Address - Country:US
Mailing Address - Phone:615-620-2320
Mailing Address - Fax:615-620-2323
Practice Address - Street 1:201 PARK ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1742
Practice Address - Country:US
Practice Address - Phone:270-781-5111
Practice Address - Fax:270-780-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty