=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316497837
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANESTHESIA SERVICES ASSOCIATES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2016
-----------------------------------------------------
Last Update Date | 10/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 623 CONGRESS PKWY S
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37303-2259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-781-1689
-----------------------------------------------------
Fax | 423-453-5017
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 623 CONGRESS PKWY S
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37303-2259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-781-1689
-----------------------------------------------------
Fax | 423-453-5017
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MANDY HAYES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 423-781-1689
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | DO0000002614
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------