=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609822998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICAN ANESTHESIOLOGY OF TENNESSEE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2006
-----------------------------------------------------
Last Update Date | 05/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 20TH ST SUITE 606
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37916-1809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-546-8040
-----------------------------------------------------
Fax | 865-541-2787
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1305 WALT WHITMAN RD STE 300
-----------------------------------------------------
City | MELVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11747-4300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-208-4250
-----------------------------------------------------
Fax | 844-206-2955
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | DR. MATTHEW WALSH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-945-3000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------