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General NPI Number Information
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NPI Number | 1881415677
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Entity Type | Organization
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Legal Business Name | IAS TENNESSEE PLLC
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 315 OAK ST
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City | LIVINGSTON
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State | TN
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Zip | 38570-1728
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Country | US
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Telephone | 931-823-5611
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Fax |
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Provider Business Mailing Address
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Address Line | 4835 LYNDON B JOHNSON FWY STE 900
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City | DALLAS
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State | TX
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Zip | 75244-6001
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Country | US
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Telephone | 469-420-5544
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NESTOR ZENAROSA
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Credential | MD
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Telephone | 469-420-5544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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