Organization
SNY CARE OF NY IV, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD LELAND HUTTON EADIE (MANAGING EMPLOYEE/AO)
(615) 733-2064
Entity
Organization
Contact information
Practice address
1131 ROUTE 55 STE 1A, LAGRANGEVILLE, NY 12540-5054
(615) 386-0064
Mailing address
102 WOODMONT BLVD STE 350, NASHVILLE, TN 37205-2216
(615) 386-0064
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
—
Other
Enumeration date
04/05/2019
Last updated
05/30/2019
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