Provider Demographics
NPI:1215923891
Name:SURGERY CENTER ANESTHESIA PLLC
Entity type:Organization
Organization Name:SURGERY CENTER ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:573-686-5550
Mailing Address - Street 1:2 QUAIL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-8866
Mailing Address - Country:US
Mailing Address - Phone:573-686-5550
Mailing Address - Fax:
Practice Address - Street 1:207 STONEBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2040
Practice Address - Country:US
Practice Address - Phone:573-686-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN09367OtherRR MEDICARE GROUP
TN3021400OtherTN BCBS
TN3623620Medicaid
TN3605893Medicaid
TN3012913OtherBCBS TN GROUP
TNCA6103OtherRR MEDICARE
TN3623620Medicare PIN
TN3605893Medicaid