Provider Demographics
NPI:1629068416
Name:SEVIER ANESTHESIA ASSOCIATES, P.C
Entity Type:Organization
Organization Name:SEVIER ANESTHESIA ASSOCIATES, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:JEFF
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:952-442-9770
Mailing Address - Street 1:400 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4552
Mailing Address - Country:US
Mailing Address - Phone:952-442-9770
Mailing Address - Fax:952-442-3630
Practice Address - Street 1:709 MIDDLE CREEK RD
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5047
Practice Address - Country:US
Practice Address - Phone:865-429-6609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN0100OtherBLUE CROSS OF TENNESSEE
TN3620339Medicaid
TN3620339Medicaid
TN3620339Medicare ID - Type Unspecified