Healthcare Provider Details

I. General information

NPI: 1528070562
Provider Name (Legal Business Name): TUCKER ANESTHESIA SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 REDBUD DR
PORTLAND TN
37148-1673
US

IV. Provider business mailing address

PO BOX 291264
NASHVILLE TN
37229-1264
US

V. Phone/Fax

Practice location:
  • Phone: 615-620-2321
  • Fax: 615-620-2323
Mailing address:
  • Phone: 615-620-2321
  • 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: WILLIAM T TUCKER
Title or Position: OWNER
Credential: CRNA
Phone: 615-620-2320