MEDICARE: ADVANCED ANESTHESIA GROUP, LLC

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	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1790720241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED ANESTHESIA GROUP, LLC

Provider Business Mailing Address
First Line	:	4800 N 22ND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4701
Country	:	US
Telephone Number	:	602-955-1000
Fax Number	:	602-508-4830

Provider Business Practice Location Address
First Line	:	1680 WILLOW CREEK RD
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86301-1108
Country	:	US
Telephone Number	:	602-955-1000
Fax Number	:	602-508-4830

Authorized Official
Title or Position	:	CFO
Name	:	DONALD SNYDER
Credential	:
Telephone Number	:	602-955-1000

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	08/03/2007

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