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General NPI Number Information
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NPI Number | 1043231202
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Entity Type | Organization
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Legal Business Name | CHATTANOOGA ANESTHESIA FOR OUTPATIENT SURGERY, PLLC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 03/01/2013
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Provider Practice Location Address
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Address Line | 400 N HOLTZCLAW AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37404-1916
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Country | US
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Telephone | 423-698-6871
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Fax |
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Provider Business Mailing Address
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Address Line | 425 LEWIS HARGETT CIR
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City | LEXINGTON
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State | KY
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Zip | 40503-3590
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Country | US
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Telephone | 859-268-1030
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Fax | 859-269-4120
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Authorized Official
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Title or Position | PRESIDENT
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Name | THEODORE H AMEREDES
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Credential | DO
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Telephone | 859-268-1030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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