Provider Demographics
NPI:1598161051
Name:CCSC ANESTHESIA LLC
Entity Type:Organization
Organization Name:CCSC ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOLST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-345-6900
Mailing Address - Street 1:401 COMMERCE ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-2446
Mailing Address - Country:US
Mailing Address - Phone:615-345-6900
Mailing Address - Fax:615-691-7214
Practice Address - Street 1:2807 CAPITAL MEDICAL BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4438
Practice Address - Country:US
Practice Address - Phone:850-402-4107
Practice Address - Fax:850-402-4108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-11
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty