Healthcare Provider Details

I. General information

NPI: 1659726933
Provider Name (Legal Business Name): ANESTHESIA SERVICES ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 LONGVIEW DR
JONESBORO AR
72401-5919
US

IV. Provider business mailing address

131 SAUNDERSVILLE RD SUITE 160
HENDERSONVILLE TN
37075-8903
US

V. Phone/Fax

Practice location:
  • Phone: 870-203-9857
  • Fax:
Mailing address:
  • Phone: 615-824-3737
  • Fax: 888-295-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: PETER KROLL
Title or Position: PRESIDENT
Credential: MD
Phone: 615-824-3737