Healthcare Provider Details

I. General information

NPI: 1871979781
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF COLUMBIA TN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 1/2 HATCHER LN
COLUMBIA TN
38401-4825
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 931-381-7818
  • Fax: 931-381-5625
Mailing address:
  • Phone: 615-240-3809
  • Fax: 615-234-1809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. PHILLIP CLENDENIN
Title or Position: PRESIDENT OF LLC
Credential:
Phone: 615-665-1283