Healthcare Provider Details

I. General information

NPI: 1194372128
Provider Name (Legal Business Name): CLEMSON ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 CLEMSON BLVD STE 200
SENECA SC
29678-4545
US

IV. Provider business mailing address

1A BURTON HILLS BLVD
NASHVILLE TN
37215-6187
US

V. Phone/Fax

Practice location:
  • Phone: 864-482-5100
  • Fax:
Mailing address:
  • Phone: 615-922-6102
  • Fax: 615-490-0102

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: ALINA LOGAN
Title or Position: VP
Credential:
Phone: 615-240-3740