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General NPI Number Information
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NPI Number | 1396767968
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Entity Type | Organization
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Legal Business Name | COOKEVILLE CARDIAC ANESTHESIA, P.C.
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 08/24/2015
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Provider Practice Location Address
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Address Line | 682 CANTER LN
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City | COOKEVILLE
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State | TN
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Zip | 38501-4523
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Country | US
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Telephone | 931-526-8513
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Fax | 931-526-5422
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Provider Business Mailing Address
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Address Line | DEPT 888152
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City | KNOXVILLE
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State | TN
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Zip | 37995-8152
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Country | US
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Telephone | 931-526-8513
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Fax | 931-526-5422
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN L CLEMONS
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Credential | M.D.
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Telephone | 931-526-8513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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