Healthcare Provider Details

I. General information

NPI: 1114347929
Provider Name (Legal Business Name): TRANQUILIZED ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5880 S HOSPITAL DR
GLOBE AZ
85501-9447
US

IV. Provider business mailing address

PO BOX 29211
PHOENIX AZ
85038-9211
US

V. Phone/Fax

Practice location:
  • Phone: 602-273-6770
  • Fax: 602-889-0483
Mailing address:
  • Phone: 602-273-6770
  • Fax: 602-889-0483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA0851
License Number StateAZ

VIII. Authorized Official

Name: STUART M. SHELLENBERGER
Title or Position: SOLE MEMBER
Credential: CRNA
Phone: 480-818-3191