Provider Demographics
NPI:1821007485
Name:HAMBLEN ANESTHESIA PC
Entity type:Organization
Organization Name:HAMBLEN ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:JR
Authorized Official - Credentials:CRNA
Authorized Official - Phone:423-581-5987
Mailing Address - Street 1:PO BOX 1718
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37816-1718
Mailing Address - Country:US
Mailing Address - Phone:423-581-5987
Mailing Address - Fax:423-581-0984
Practice Address - Street 1:216 S HENRY ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2215
Practice Address - Country:US
Practice Address - Phone:423-581-5984
Practice Address - Fax:423-581-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3704516Medicare ID - Type Unspecified
TN3622364Medicare ID - Type Unspecified