1275859787 NPI number — CLARKSVILLE ANESTHESIA LLC

Table of content: (NPI 1275859787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275859787 NPI number — CLARKSVILLE ANESTHESIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLARKSVILLE 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:
1275859787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4860
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRELLS INLET
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29576-2698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-651-2624
Provider Business Mailing Address Fax Number:
843-357-4940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
132 HILLCREST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37043-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-552-0180
Provider Business Practice Location Address Fax Number:
931-572-0915
Provider Enumeration Date:
04/09/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MITCHELL
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
T
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
843-651-2624

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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