1588740971 NPI number — CERTIFIED ANESTHESIA SERVICES, LTD.

Table of content: (NPI 1588740971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588740971 NPI number — CERTIFIED ANESTHESIA SERVICES, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CERTIFIED ANESTHESIA SERVICES, LTD.
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:
1588740971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2358
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAYSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85547-2358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-472-2311
Provider Business Mailing Address Fax Number:
928-472-9174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
807 S PONDEROSA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAYSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85541-5542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-472-1367
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRUBBS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
C
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
928-474-4923

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN059709 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AZ5877 . This is a "JCG HEALTHNET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1639255037 . This is a "NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0161970 . This is a "PM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ5785 . This is a "WKM HEALTHNET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 750423 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZ0163560 . This is a "WM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 18042985 . This is a "WORKER'S COMP." identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0480270 . This is a "JG BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 750431 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 750449 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZ5790 . This is a "PM HEALTHNET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com