Healthcare Provider Details

I. General information

NPI: 1811230022
Provider Name (Legal Business Name): AMSURG SOUTH BAY ANESTHESIA LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23560 MADISON ST STE 109
TORRANCE CA
90505-4709
US

IV. Provider business mailing address

1A BURTON HILLS BLVD ATTN: PROVIDER ENROLLMENT
NASHVILLE TN
37215-6187
US

V. Phone/Fax

Practice location:
  • Phone: 310-325-6331
  • Fax: 310-325-6335
Mailing address:
  • Phone: 615-240-3809
  • Fax: 615-234-1809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. JEAN KOCHENDORFER
Title or Position: SR DIRECTOR OF RCM TRANSFORMATION
Credential:
Phone: 615-263-4012