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General NPI Number Information
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NPI Number | 1336209303
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Entity Type | Organization
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Legal Business Name | SYCAMORE ANESTHESIA SERVICES, LLC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 1421 N 7TH ST
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City | TERRE HAUTE
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State | IN
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Zip | 47807-1005
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Country | US
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Telephone | 812-231-4608
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Fax | 812-231-4675
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Provider Business Mailing Address
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Address Line | PO BOX 3036
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-3036
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Country | US
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Telephone | 812-231-4608
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Fax | 812-231-4675
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS M PENDERGAST
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Credential | M.D.
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Telephone | 812-231-4608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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