Provider Demographics
NPI:1871677146
Name:WARREN ANESTHESIA ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:WARREN ANESTHESIA ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:POINT OF CONTACT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:423-894-5466
Mailing Address - Street 1:5751 UPTAIN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-5671
Mailing Address - Country:US
Mailing Address - Phone:423-424-3623
Mailing Address - Fax:
Practice Address - Street 1:1559 SPARTA RD
Practice Address - Street 2:RIVER PARK HOSPITAL
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110
Practice Address - Country:US
Practice Address - Phone:423-855-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3623327Medicaid
CN2475OtherRR MEDICARE
TN3623327Medicare PIN