Healthcare Provider Details

I. General information

NPI: 1164749842
Provider Name (Legal Business Name): AMSURG SAN LUIS OBISPO ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CASA ST SUITE 106
SAN LUIS OBISPO CA
93405-5803
US

IV. Provider business mailing address

1A BURTON HILLS BLVD STE 300
NASHVILLE TN
37215-6153
US

V. Phone/Fax

Practice location:
  • Phone: 805-541-1021
  • Fax: 615-234-1720
Mailing address:
  • Phone: 615-240-3809
  • Fax: 615-234-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. PHILLIP CLENDENIN
Title or Position: PRESIDENT OF LP
Credential:
Phone: 615-665-1283