# BRIGHAM ANESTHESIA SOUTH LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699769232
- **Authorized official:** DR. GARDNER THOMAS KENNY MD (MANAGING MEMBER)
- **Authorized official phone:** (618) 457-5111

## Contact information

- **Practice address:** 405 W JACKSON ST, MEMORIAL HOSPITAL OF CARBONDALE, CARBONDALE, IL 62901-1462
- **Practice address phone:** (618) 549-0721
- **Practice address fax:** (618) 351-4849
- **Mailing address:** 35 ALBANY RD, SUITE C, CARBONDALE, IL 62903-7605
- **Mailing address phone:** (618) 457-5111
- **Mailing address fax:** (618) 457-6560

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/09/2005
- **Last updated:** 08/04/2011