Organization
AMSURG PORT ORANGE ANESTHESIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILLIP A. CLENDENIN (PRESIDENT)
(615) 665-1283
Entity
Organization
Contact information
Practice address
3635 S CLYDE MORRIS BLVD, SUITE 500, PORT ORANGE, FL 32129-2300
(386) 760-8151
Mailing address
1A BURTON HILLS BLVD, ATTN: PROVIDER ENROLLMENT, NASHVILLE, TN 37215-6187
(615) 240-3809
(615) 234-1809
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
04/18/2013
Last updated
08/09/2016
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