1215932413 NPI number — ANESTHESIA MEDICAL GROUP, PC

Table of content: (NPI 1215932413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215932413 NPI number — ANESTHESIA MEDICAL GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANESTHESIA MEDICAL GROUP, PC
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:
Provider Other Organization Name Type Code:
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:
1215932413
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 29TH AVE N
Provider Second Line Business Mailing Address:
STE 301
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-1448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-327-4304
Provider Business Mailing Address Fax Number:
615-327-5435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 29TH AVE N
Provider Second Line Business Practice Location Address:
STE 301
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-327-4304
Provider Business Practice Location Address Fax Number:
615-327-5435
Provider Enumeration Date:
06/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FORREST
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
615-327-4304

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7100516010 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3372977 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 710051600 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3604122 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65910465 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 529402690 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74903824 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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