1104854124 NPI number — ANESTHESIA SERVICES ASSOCIATES PLLC

Table of content: (NPI 1104854124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104854124 NPI number — ANESTHESIA SERVICES ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANESTHESIA SERVICES ASSOCIATES 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:
1104854124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 SAUNDERSVILLE
Provider Second Line Business Mailing Address:
STE 160
Provider Business Mailing Address City Name:
HENDERSONVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37075-8940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-824-3737
Provider Business Mailing Address Fax Number:
888-687-6133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 SAUNDERSVILLE ROAD
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-824-3737
Provider Business Practice Location Address Fax Number:
888-295-1610
Provider Enumeration Date:
06/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DICKERSON
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
REID
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-824-3737

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; 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: 4024917 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 74900192 . This is a "KY MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3630916 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH3745 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 100696999 . This is a "AMERIGROUP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3721382 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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