Healthcare Provider Details

I. General information

NPI: 1942858394
Provider Name (Legal Business Name): FOREFRONT ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 WARFIELD BLVD
CLARKSVILLE TN
37043-1828
US

IV. Provider business mailing address

PO BOX 292122
NASHVILLE TN
37229-2122
US

V. Phone/Fax

Practice location:
  • Phone: 615-620-2333
  • Fax: 615-620-2323
Mailing address:
  • Phone: 615-620-2333
  • Fax: 615-620-2323

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: KYLE MAROSE
Title or Position: OWNER
Credential:
Phone: 574-551-5105