1841334364 NPI number — INDEPENDENT ANESTHESIOLOGY, A MEDICAL GROUP

Table of content: (NPI 1841334364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841334364 NPI number — INDEPENDENT ANESTHESIOLOGY, A MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDEPENDENT ANESTHESIOLOGY, A MEDICAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
IAMG
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841334364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10790
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92711-0790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-992-4444
Provider Business Mailing Address Fax Number:
714-879-9999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 N TUSTIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92705-3502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-835-3555
Provider Business Practice Location Address Fax Number:
714-953-3542
Provider Enumeration Date:
02/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
COLLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
AGENT
Authorized Official Telephone Number:
714-992-4444

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZZ47026Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0066370 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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