1033162045 NPI number — RESOURCE ANESTHESIA, P.C.

Table of content: MR. GREGORY NELSON ANDERSON MS, CCC-SLP (NPI 1952643900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033162045 NPI number — RESOURCE ANESTHESIA, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESOURCE ANESTHESIA, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LOUDON ANESTHESIA ASSOCIATES, PC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033162045
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12752 KINGSTON PIKE
Provider Second Line Business Mailing Address:
STE E202
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37934-0948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-777-0909
Provider Business Mailing Address Fax Number:
865-777-0910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 FORT LOUDOUN MEDICAL CENTER DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENOIR CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37772-5673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-271-6000
Provider Business Practice Location Address Fax Number:
865-777-0910
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAYNIE
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
KENT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
865-777-0909

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 323889 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 74900648 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000267221 . This is a "ANTHEM BCBS KY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 4022215 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3630129 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 536581 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: DD8474 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200200040A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: CJ4420 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: DN3970 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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