1306192059 NPI number — RESOURCE ANESTHESIA KENTUCKY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306192059 NPI number — RESOURCE ANESTHESIA KENTUCKY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESOURCE ANESTHESIA KENTUCKY INC
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:
1306192059
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2012
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:
SUITE 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:
305 ESTILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEREA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40403-1742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-986-3151
Provider Business Practice Location Address Fax Number:
865-777-0910
Provider Enumeration Date:
07/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MCMILLAN
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
TEAM LEAD/CREDENTIALS MANAGER
Authorized Official Telephone Number:
865-777-0909

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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