Basic Information
| Provider Information | |||||||||
| NPI: | 1932521366 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMSURG MDSINE 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: | 55 SAINT GEORGE RD | ||||||||
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| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011043333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137367463 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2014 | ||||||||
| LastUpdateDate: | 08/12/2016 | ||||||||
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| AuthorizedOfficialLastName: | CLENDENIN | ||||||||
| AuthorizedOfficialFirstName: | PHILLIP | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6156651283 | ||||||||
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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 | 367500000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.