Healthcare Provider Details

I. General information

NPI: 1023044377
Provider Name (Legal Business Name): MIDSTATE ANESTHESIOLOGISTS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 N 16TH ST SUITE 150
PHOENIX AZ
85020-4431
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267-0096
US

V. Phone/Fax

Practice location:
  • Phone: 602-395-0718
  • Fax: 602-277-8146
Mailing address:
  • Phone: 209-956-7725
  • Fax: 209-956-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number13790
License Number StateAZ

VIII. Authorized Official

Name: ASHLEY TRYON
Title or Position: OFFICE MANAGER
Credential:
Phone: 209-956-7725