1336857085 NPI number — ANESTHESIA SERVICES OF ARIZONA PC

Table of content: (NPI 1336857085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336857085 NPI number — ANESTHESIA SERVICES OF ARIZONA PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANESTHESIA SERVICES OF ARIZONA PC
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:
Provider Other Organization Name Type Code:
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:
1336857085
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
265 BROOKVIEW CENTRE WAY STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37919-4052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-985-7114
Provider Business Mailing Address Fax Number:
865-692-5867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5700 E HIGHWAY 90
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIERRA VISTA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85635-9110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-263-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TIBEDO
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
MELISSA
Authorized Official Title or Position:
NATIONAL PE DIRECTOR
Authorized Official Telephone Number:
865-985-7130

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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