Healthcare Provider Details

I. General information

NPI: 1609120070
Provider Name (Legal Business Name): ECGJ ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 06/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 WELLINGTON AVE
GRAND JUNCTION CO
81501-8122
US

IV. Provider business mailing address

401 COMMERCE ST STE 600
NASHVILLE TN
37219-2446
US

V. Phone/Fax

Practice location:
  • Phone: 615-346-5879
  • Fax: 615-346-5879
Mailing address:
  • Phone: 615-843-4102
  • Fax: 615-691-7214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. CHAD L STEVENS
Title or Position: PRESIDENT BOARD OF MANAGERS
Credential:
Phone: 615-345-6868