Healthcare Provider Details

I. General information

NPI: 1144429358
Provider Name (Legal Business Name): UNION CITY ANESTHESIA GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BISHOP ST
UNION CITY TN
38261-5403
US

IV. Provider business mailing address

PO BOX 387
UNION CITY TN
38281-0387
US

V. Phone/Fax

Practice location:
  • Phone: 731-885-0787
  • Fax: 731-885-0756
Mailing address:
  • Phone: 731-885-0787
  • Fax: 731-885-0756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: BETH BIVENS
Title or Position: OFFICE MANAGER
Credential:
Phone: 731-885-0787