Provider Demographics
NPI:1427098813
Name:NEUROSURGICAL ANESTHESIOLOGIST,PLC
Entity type:Organization
Organization Name:NEUROSURGICAL ANESTHESIOLOGIST,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:W
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:WORTHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-714-9013
Mailing Address - Street 1:2011 MURPHY AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2023
Mailing Address - Country:US
Mailing Address - Phone:615-515-8350
Mailing Address - Fax:615-284-2973
Practice Address - Street 1:2011 MURPHY AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2023
Practice Address - Country:US
Practice Address - Phone:615-515-8350
Practice Address - Fax:615-284-2973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherIRS TAX ID NUMBER