Basic Information
| Provider Information | |||||||||
| NPI: | 1033162045 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RESOURCE ANESTHESIA, P.C. | ||||||||
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| OtherOrganizationName: | LOUDON ANESTHESIA ASSOCIATES, PC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12752 KINGSTON PIKE | ||||||||
| Address2: | STE E202 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379340948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8657770909 | ||||||||
| FaxNumber: | 8657770910 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 FORT LOUDOUN MEDICAL CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | LENOIR CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377725673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652716000 | ||||||||
| FaxNumber: | 8657770910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 04/09/2014 | ||||||||
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| AuthorizedOfficialLastName: | HAYNIE | ||||||||
| AuthorizedOfficialFirstName: | PHILLIP | ||||||||
| AuthorizedOfficialMiddleName: | KENT | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8657770909 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MSN-CRNA, MBA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 323889 | 01 | KY | BLUE CROSS/BLUE SHIELD | OTHER | 74900648 | 05 | KY | MEDICAID | 000000267221 | 01 | KY | ANTHEM BCBS KY | OTHER | 4022215 | 01 | TN | BLUE CROSS/BLUE SHIELD | OTHER | 3630129 | 05 | TN | MEDICAID | 536581 | 05 | AZ | MEDICAID | DD8474 | 01 | KY | RAILROAD MEDICARE | OTHER | 200200040A | 05 | OK | MEDICAID | CJ4420 | 01 | TN | RAILROAD MEDICARE | OTHER | DN3970 | 01 | OK | RAILROAD MEDICARE | OTHER |