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General NPI Number Information
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NPI Number | 1316179963
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Entity Type | Organization
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Legal Business Name | SHENANDOAH TX ENDOSCOPY ASC LLC
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Dates
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Enumeration Date | 08/17/2009
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 111 VISION PARK BLVD SUITE 160
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City | SHENANDOAH
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State | TX
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Zip | 77384-3002
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Country | US
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Telephone | 936-321-8910
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Fax | 936-321-8913
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Provider Business Mailing Address
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Address Line | 20 BURTON HILLS BLVD SUITE 500
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City | NASHVILLE
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State | TN
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Zip | 37215-6197
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Country | US
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Telephone | 615-240-3720
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Fax | 615-234-1720
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PHILLIP A CLENDENIN
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Credential |
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Telephone | 615-665-1283
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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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