Healthcare Provider Details

I. General information

NPI: 1578754263
Provider Name (Legal Business Name): ANESTHESIA CARE OF CORBIN PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRILLIUM WAY
CORBIN KY
40701-8426
US

IV. Provider business mailing address

PO BOX 10484
BIRMINGHAM AL
35202-0484
US

V. Phone/Fax

Practice location:
  • Phone: 901-892-7161
  • Fax:
Mailing address:
  • Phone: 205-322-1808
  • Fax: 205-322-1851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALAN DALE HILLIARD
Title or Position: CFO
Credential:
Phone: 205-322-1808