Healthcare Provider Details

I. General information

NPI: 1750016531
Provider Name (Legal Business Name): ANESTHESIA SERVICES OF AMERICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14155 N 83RD AVE STE 140
PEORIA AZ
85381-5652
US

IV. Provider business mailing address

PO BOX 2137
SUN CITY AZ
85372-2137
US

V. Phone/Fax

Practice location:
  • Phone: 605-510-3203
  • Fax:
Mailing address:
  • Phone: 908-653-9399
  • Fax: 908-653-9305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MOHAMAD KHARAZZI
Title or Position: CEO
Credential: MD
Phone: 908-653-9399