Basic Information
| Provider Information | |||||||||
| NPI: | 1750399127 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIA AND PAIN CONSULTANTS,P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1009 NOVUS DR STE 2 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376048237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232830776 | ||||||||
| FaxNumber: | 4232830549 | ||||||||
| Practice Location | |||||||||
| Address1: | 1009 LARK ST STE 2 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376048218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232830776 | ||||||||
| FaxNumber: | 4232830549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | QUALLS | ||||||||
| AuthorizedOfficialFirstName: | PARRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4232830776 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 3624610 | 05 | TN | MEDICAID | 3708989 | 05 | TN | MEDICAID |