Healthcare Provider Details

I. General information

NPI: 1477846673
Provider Name (Legal Business Name): AEPC ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 COMMERCE ST SUITE 600
NASHVILLE TN
37219-2446
US

IV. Provider business mailing address

1753 W AVENUE J SUITE A
LANCASTER CA
93534-9823
US

V. Phone/Fax

Practice location:
  • Phone: 615-345-6900
  • Fax: 615-691-7214
Mailing address:
  • Phone: 661-206-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID W HOLST
Title or Position: PRESIDENT BOARD OF MANAGERS
Credential:
Phone: 615-345-6900