1609120070 NPI number — ECGJ ANESTHESIA LLC

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 1609120070 NPI number — ECGJ ANESTHESIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ECGJ ANESTHESIA LLC
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:
1609120070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 COMMERCE ST
Provider Second Line Business Mailing Address:
STE 600
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37219-2446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-843-4102
Provider Business Mailing Address Fax Number:
615-691-7214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1035 WELLINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND JUNCTION
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81501-8122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-346-5879
Provider Business Practice Location Address Fax Number:
615-346-5879
Provider Enumeration Date:
11/06/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STEVENS
Authorized Official First Name:
CHAD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT BOARD OF MANAGERS
Authorized Official Telephone Number:
615-345-6868

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)