Provider Demographics
NPI:1982658019
Name:DEERCREEK ANESTHESIA CONSULTANTS PLLC
Entity Type:Organization
Organization Name:DEERCREEK ANESTHESIA CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LASALLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:931-456-4433
Mailing Address - Street 1:1307 WEST AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-5107
Mailing Address - Country:US
Mailing Address - Phone:931-456-4433
Mailing Address - Fax:931-456-4405
Practice Address - Street 1:1307 WEST AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-5107
Practice Address - Country:US
Practice Address - Phone:931-456-4433
Practice Address - Fax:931-456-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3713499Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER