Provider Demographics
NPI:1760593834
Name:PREMIER ANESTHESIA SERVICES PC
Entity Type:Organization
Organization Name:PREMIER ANESTHESIA SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTAINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-239-5833
Mailing Address - Street 1:P.O. BOX 3409
Mailing Address - Street 2:SUITE 207
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-0409
Mailing Address - Country:US
Mailing Address - Phone:423-239-5833
Mailing Address - Fax:423-239-9789
Practice Address - Street 1:2000 BROOKSIDE DRIVE
Practice Address - Street 2:SUITE 207
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4627
Practice Address - Country:US
Practice Address - Phone:423-239-5833
Practice Address - Fax:423-239-9789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty