Provider Demographics
NPI: | 1841586922 |
---|---|
Name: | AMSURG CHATTANOOGA ANESTHESIA LLC |
Entity Type: | Organization |
Organization Name: | AMSURG CHATTANOOGA ANESTHESIA LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | PHILLIP |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CLENDENIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 615-665-1283 |
Mailing Address - Street 1: | 1A BURTON HILLS BLVD |
Mailing Address - Street 2: | ATTN: PROVIDER ENROLLMENT |
Mailing Address - City: | NASHVILLE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37215-6187 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-240-3809 |
Mailing Address - Fax: | 615-234-1809 |
Practice Address - Street 1: | 2341 MCCALLIE AVE |
Practice Address - Street 2: | STE 303 |
Practice Address - City: | CHATTANOOGA |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37404-3239 |
Practice Address - Country: | US |
Practice Address - Phone: | 423-698-3999 |
Practice Address - Fax: | 423-698-0903 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-06-27 |
Last Update Date: | 2016-08-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Single Specialty |