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General NPI Number Information
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NPI Number | 1972929925
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Entity Type | Organization
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Legal Business Name | AMSURG MARIN ANESTHESIA LP
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Dates
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Enumeration Date | 03/14/2014
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 1100 SOUTH ELISCO DRIVE SUITE 3
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City | GREENBRAE
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State | CA
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Zip | 94904-2017
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Country | US
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Telephone | 415-464-0606
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Fax | 415-646-0644
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Provider Business Mailing Address
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Address Line | 20 BURTON HILLS BLVD SUITE 500, ATTN: L&C
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City | NASHVILLE
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State | TN
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Zip | 37215-6197
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Country | US
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Telephone | 615-240-3820
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Fax | 615-234-1720
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PHILLIP CLENDENIN
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Credential |
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Telephone | 615-665-1283
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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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