Healthcare Provider Details

I. General information

NPI: 1588740971
Provider Name (Legal Business Name): CERTIFIED ANESTHESIA SERVICES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 S PONDEROSA ST
PAYSON AZ
85541-5542
US

IV. Provider business mailing address

PO BOX 2358
PAYSON AZ
85547-2358
US

V. Phone/Fax

Practice location:
  • Phone: 928-472-1367
  • Fax:
Mailing address:
  • Phone: 928-472-2311
  • Fax: 928-472-9174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN059709
License Number StateAZ

VIII. Authorized Official

Name: MR. JAMES C GRUBBS
Title or Position: VICE-PRESIDENT
Credential: CRNA
Phone: 928-474-4923