Provider Demographics
NPI:1538174974
Name:PARAGON ANESTHESIA PC
Entity type:Organization
Organization Name:PARAGON ANESTHESIA PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-390-0450
Mailing Address - Street 1:10415 WALLACE ALLEY ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-3936
Mailing Address - Country:US
Mailing Address - Phone:423-390-0451
Mailing Address - Fax:423-212-0580
Practice Address - Street 1:10415 WALLACE ALLEY ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-3936
Practice Address - Country:US
Practice Address - Phone:423-390-0451
Practice Address - Fax:423-968-5697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3380989Medicare ID - Type UnspecifiedMEDICARE