Healthcare Provider Details

I. General information

NPI: 1720326226
Provider Name (Legal Business Name): AMSURG WESTMINSTER ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 WASHINGTON HEIGHTS MED CTR STE B
WESTMINSTER MD
21157-5665
US

IV. Provider business mailing address

1A BURTON HILLS BLVD ATTN: PROVIDER ENROLLMENT
NASHVILLE TN
37215-6187
US

V. Phone/Fax

Practice location:
  • Phone: 410-857-5113
  • Fax: 410-840-8344
Mailing address:
  • Phone: 615-240-3809
  • Fax: 615-234-1809

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: PHILLIP CLENDENIN
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283