Healthcare Provider Details

I. General information

NPI: 1427342724
Provider Name (Legal Business Name): HUALAPAI MOUNTAIN ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 SANTA ROSA DR
KINGMAN AZ
86401-2311
US

IV. Provider business mailing address

3727 CERBAT VISTA DR
KINGMAN AZ
86409-6950
US

V. Phone/Fax

Practice location:
  • Phone: 928-263-5100
  • Fax:
Mailing address:
  • Phone: 928-757-7976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GORDON BURNS
Title or Position: MD/OWNER
Credential: MD
Phone: 928-757-7976