Healthcare Provider Details

I. General information

NPI: 1124649389
Provider Name (Legal Business Name): SOUTHWEST ANESTHESIA PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N SWITZER CANYON DR
FLAGSTAFF AZ
86001-4845
US

IV. Provider business mailing address

2733 N POWER RD
MESA AZ
85215-1682
US

V. Phone/Fax

Practice location:
  • Phone: 800-460-0623
  • Fax:
Mailing address:
  • Phone: 800-460-0623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: CHARLES BEAULIEU
Title or Position: PRESIDENT
Credential: MD
Phone: 480-213-8451