Healthcare Provider Details

I. General information

NPI: 1164482790
Provider Name (Legal Business Name): GLOBE CRNA COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/21/2022
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 1193
GLOBE AZ
85502-1193
US

V. Phone/Fax

Practice location:
  • Phone: 928-402-1217
  • Fax: 928-402-1218
Mailing address:
  • Phone: 928-402-1217
  • Fax: 928-402-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SCOTT SHUMWAY
Title or Position: PARTNER
Credential: CRNA
Phone: 928-200-5257