Healthcare Provider Details

I. General information

NPI: 1659625788
Provider Name (Legal Business Name): RESOURCE ANESTHISIA CUMBERLAND VALLEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL CENTER DR SUITE 2B
HAZARD KY
41701-9466
US

IV. Provider business mailing address

12752 KINGSTON PIKE SUITE E202
KNOXVILLE TN
37934-0948
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-3952
  • Fax: 865-777-0910
Mailing address:
  • Phone: 865-777-0909
  • Fax: 865-777-0910

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. PHILLIP RENEE MCMILLAN
Title or Position: PRESIDENT
Credential: CRNA
Phone: 865-777-0909