Healthcare Provider Details

I. General information

NPI: 1275084386
Provider Name (Legal Business Name): KNOXVILLE EYE ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 E WEISGARBER RD SUITE 110
KNOXVILLE TN
37909-2686
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 865-588-1037
  • Fax: 865-909-9104
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: 615-665-1384