Provider Demographics
NPI:1982927778
Name:ANESTHESIA OF NORTHEAST TENNESSEE PLLC
Entity type:Organization
Organization Name:ANESTHESIA OF NORTHEAST TENNESSEE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-651-2624
Mailing Address - Street 1:PO BOX 4860
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-2698
Mailing Address - Country:US
Mailing Address - Phone:843-651-2624
Mailing Address - Fax:843-357-4940
Practice Address - Street 1:310 N STATE OF FRANKLIN RD
Practice Address - Street 2:STE 202
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6008
Practice Address - Country:US
Practice Address - Phone:423-928-8973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty