1548565245 NPI number — MID SOUTH ANESTHESIA PC

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 1548565245 NPI number — MID SOUTH ANESTHESIA PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID SOUTH ANESTHESIA 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:
1548565245
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37088-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-444-2320
Provider Business Mailing Address Fax Number:
615-547-9845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
322 22ND AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37203-1842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-444-2320
Provider Business Practice Location Address Fax Number:
615-547-9845
Provider Enumeration Date:
01/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DAVENPORT
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
615-444-2320

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  R0000058326 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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