Individual provider Active NPI

David E Latham, CRNA

  • Certified Registered Nurse Anesthetist
  • Greeneville, TN
National Provider Identifier
1487623682
Registry record updated Sep 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN0000039907 Issued in TN
Practice address
1104 Tusculum Blvd
Suite 114
Greeneville, TN 37745-4091
Phone
(423) 639-0941
Fax
(423) 638-3401
NPI assigned
Mar 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN0000039907 TN Primary
Certified Registered Nurse Anesthetist 367500000X 8864 TN

Addresses

Primary practice location

1104 Tusculum Blvd
Suite 114
Greeneville, TN 37745-4091

Mailing address

PO Box 896138
Charlotte, NC 28289-6138
Phone (423) 639-0941

Other identifiers 2

IdentifierTypeStateIssuer
3052082OtherTNBC/BS, BLUECARE, TENNCARE
3603521MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
8864TNMDCertified Registered Nurse Anesthetist
RN0000039907TNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Greeneville Anesthesia Services Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2006 Accepting new patients
Anesthesiologists Associated PC Past Accepting new patients
Anesthesiologists Associated PC Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

1104 Tusculum Blvd
Ste 114
Greeneville, TN 37745
Phone (833) 500-9914

1104 Tusculum Blvd
Ste 303
Greeneville, TN 37745
Phone (423) 636-8600

1104 Tusculum Blvd
Greeneville, TN 37745
Phone (423) 636-8600

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410739200000",
    "number": "1487623682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 896138",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282896138",
            "telephone_number": "423-639-0941",
            "fax_number": "423-638-3401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 TUSCULUM BLVD",
            "address_2": "SUITE 114",
            "city": "GREENEVILLE",
            "state": "TN",
            "postal_code": "377454091",
            "telephone_number": "423-639-0941",
            "fax_number": "423-638-3401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATHAM",
        "first_name": "DAVID",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2014-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "RN0000039907",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "8864",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS, BLUECARE, TENNCARE",
            "identifier": "3052082",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3603521",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greeneville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.