1073658415 NPI number — ANESTHESIA CARE SERVICES PLLC

Table of content: (NPI 1073658415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073658415 NPI number — ANESTHESIA CARE SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANESTHESIA CARE SERVICES PLLC
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:
1073658415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34756
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38184-0756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-382-1200
Provider Business Mailing Address Fax Number:
901-382-8070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 E TICKLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DYERSBURG
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38024-3119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-382-1200
Provider Business Practice Location Address Fax Number:
901-382-8070
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARSOTTI
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
901-827-8111

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367H00000X , with the licence number: APN0000008853 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1527735 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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