Healthcare Provider Details

I. General information

NPI: 1770129066
Provider Name (Legal Business Name): TERRE HAUTE ANESTHESIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 S 7TH ST
TERRE HAUTE IN
47802-5709
US

IV. Provider business mailing address

110 29TH AVE N STE 200
NASHVILLE TN
37203-6002
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-4304
  • Fax: 615-327-7940
Mailing address:
  • Phone: 615-327-4304
  • Fax: 615-327-7940

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: PATRICK FORREST
Title or Position: PRESIDENT
Credential: MD
Phone: 615-327-4304