Basic Information
| Provider Information | |||||||||
| NPI: | 1194117242 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH CENTRAL ANESTHESIA ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5000 | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370885000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154442320 | ||||||||
| FaxNumber: | 6155479845 | ||||||||
| Practice Location | |||||||||
| Address1: | 155 STONE TRACE DR | ||||||||
| Address2: | |||||||||
| City: | ALVATON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421227809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707796696 | ||||||||
| FaxNumber: | 6155479845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2015 | ||||||||
| LastUpdateDate: | 02/26/2015 | ||||||||
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| AuthorizedOfficialLastName: | DICKINSON | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CRNA/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2707796696 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.