Healthcare Provider Details

I. General information

NPI: 1134683758
Provider Name (Legal Business Name): MOLINE ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 VALLEY VIEW DR
MOLINE IL
61265-6138
US

IV. Provider business mailing address

401 COMMERCE ST STE 600
NASHVILLE TN
37219-2518
US

V. Phone/Fax

Practice location:
  • Phone: 309-762-5560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JEANNE DESAUTELS
Title or Position: PRESIDENT
Credential:
Phone: 615-345-6900