NPIMap

Organization Active NPI

Brigham Anesthesia South LLC

  • Anesthesiology Physician
  • Carbondale, IL
National Provider Identifier
1699769232
Registry record updated Aug 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
BRIGHAM ANESTHESIA SOUTH LLC
Practice address
405 W Jackson St
Memorial Hospital of Carbondale
Carbondale, IL 62901-1462
Phone
(618) 549-0721
Fax
(618) 351-4849
NPI assigned
Sep 9, 2005
Last updated
Aug 4, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2011

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

Authorized official

Name
Dr. Gardner Thomas Kenny, MDNPI 1851383947
Title
Managing Member
Phone
(618) 457-5111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

405 W Jackson St
Memorial Hospital of Carbondale
Carbondale, IL 62901-1462

Mailing address

35 Albany Rd
Suite C
Carbondale, IL 62903-7605
Phone (618) 457-5111

National Provider Directory

National Provider Directory

Locations

35 Albany Rd
Ste C
Carbondale, IL 62903
Phone (618) 457-5111

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312416000000",
    "number": "1699769232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 ALBANY RD",
            "address_2": "SUITE C",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629037605",
            "telephone_number": "618-457-5111",
            "fax_number": "618-457-6560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 W JACKSON ST",
            "address_2": "MEMORIAL HOSPITAL OF CARBONDALE",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011462",
            "telephone_number": "618-549-0721",
            "fax_number": "618-351-4849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIGHAM ANESTHESIA SOUTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-09",
        "last_updated": "2011-08-04",
        "status": "A",
        "authorized_official_last_name": "KENNY",
        "authorized_official_first_name": "GARDNER",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "618-457-5111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2011; 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.