Basic Information
| Provider Information | |||||||||
| NPI: | 1487056388 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMSURG INDIANAPOLIS ANESTHESIA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1A BURTON HILLS BLVD | ||||||||
| Address2: | ATTN: PROVIDER ENROLLMENT | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372156187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152403809 | ||||||||
| FaxNumber: | 6152341809 | ||||||||
| Practice Location | |||||||||
| Address1: | 8424 NABB ROAD | ||||||||
| Address2: | SUITE 3-G | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462601975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178717308 | ||||||||
| FaxNumber: | 3178717314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2014 | ||||||||
| LastUpdateDate: | 08/09/2016 | ||||||||
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| AuthorizedOfficialLastName: | CLENDENIN | ||||||||
| AuthorizedOfficialFirstName: | PHILLIP | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6156651283 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.