MEDICARE: AMBULATORY MEDICAL ASSOCIATES-CO, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	DR51450	CO

General Provider Information

NPI Number	:	1598011025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBULATORY MEDICAL ASSOCIATES-CO, PLLC

Provider Business Mailing Address
First Line	:	8433 N BLACK CANYON HWY STE 130
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4859
Country	:	US
Telephone Number	:	602-687-8189
Fax Number	:	888-505-6003

Provider Business Practice Location Address
First Line	:	8433 N BLACK CANYON HWY STE 130
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4859
Country	:	US
Telephone Number	:	602-687-8189
Fax Number	:	888-505-6003

Authorized Official
Title or Position	:	ANESTHESIOLOGY
Name	:	DR. CHRISTOPHER S RAY
Credential	:	M.D.
Telephone Number	:	602-687-8189

Provider Enumeration Date	:	08/02/2012
Last Update Date	:	08/02/2012

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