Organization
BRIGHAM ANESTHESIA SOUTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARDNER THOMAS KENNY MD (MANAGING MEMBER)
(618) 457-5111
Entity
Organization
Contact information
Practice address
405 W JACKSON ST, MEMORIAL HOSPITAL OF CARBONDALE, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 351-4849
Mailing address
35 ALBANY RD, SUITE C, CARBONDALE, IL 62903-7605
(618) 457-5111
(618) 457-6560
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
09/09/2005
Last updated
08/04/2011
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