Brigham Anesthesia South LLC

NPI #1699769232 in Carbondale, Illinois

Provider Information

NPI Number: 1699769232
Entity Type: Organization
Organization Name: Brigham Anesthesia South LLC
Primary Specialty: Anesthesiology
Enumeration Date: Sep 9, 2005
Last Updated: Aug 4, 2011

Practice Location

Address: 405 W JACKSON ST
Address 2: MEMORIAL HOSPITAL OF CARBONDALE
City: Carbondale
State: Illinois
ZIP Code: 62901-1462
Phone: (618) 549-0721

Authorized Official

Name: DR. GARDNER THOMAS KENNY, MD
Title: MANAGING MEMBER
Phone: (618) 457-5111

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Anesthesiology	207L00000X	Primary

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