1144573015 NPI number — RESOURCE ANESTHESIA LAKEWAY, INC.

Table of content: (NPI 1144573015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144573015 NPI number — RESOURCE ANESTHESIA LAKEWAY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESOURCE ANESTHESIA LAKEWAY, 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:
1144573015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2012
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:
639 PENNTON AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENOIR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28645-5743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-572-1770
Provider Business Practice Location Address Fax Number:
865-777-0910
Provider Enumeration Date:
10/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MCMILLAN
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
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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