Provider Demographics
NPI:1619265550
Name:TENNESSEE ANESTHESIOLOGY LLC
Entity Type:Organization
Organization Name:TENNESSEE ANESTHESIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-392-6100
Mailing Address - Street 1:2204 PAVILION DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4657
Mailing Address - Country:US
Mailing Address - Phone:423-392-6100
Mailing Address - Fax:423-392-6159
Practice Address - Street 1:2204 PAVILION DR
Practice Address - Street 2:SUITE 105
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4657
Practice Address - Country:US
Practice Address - Phone:423-392-0344
Practice Address - Fax:423-392-6159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-13
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525088Medicaid
TN4306528OtherBCBSTN
TN4306528OtherBLUECARE
TN103G700017Medicare PIN