Organization
WEST TENNESSEE ANESTHESIA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW SHANE LONG CRNA (CFO)
(731) 664-1717
Entity
Organization
Contact information
Practice address
17C BRENTSHIRE SQUARE, JACKSON, TN 38305-2273
(731) 664-1717
(731) 664-7114
Mailing address
17C BRENTSHIRE SQUARE, JACKSON, TN 38305-2273
(731) 664-1717
(731) 664-7114
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3604177
—
TN
Enumeration date
11/03/2006
Last updated
07/21/2022
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