Healthcare Provider Details

I. General information

NPI: 1174753396
Provider Name (Legal Business Name): GLOBAL ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6245 N 16TH ST
PHOENIX AZ
85016-1706
US

IV. Provider business mailing address

PO BOX 39179
PHOENIX AZ
85069-9179
US

V. Phone/Fax

Practice location:
  • Phone: 602-792-5769
  • Fax: 602-253-4273
Mailing address:
  • Phone: 602-395-0718
  • Fax: 602-277-8146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number33804
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number37002
License Number StateAZ

VIII. Authorized Official

Name: MRS. BOBBIE RONSMAN
Title or Position: CREDENTIALING ADMINISTRATOR
Credential:
Phone: 602-308-7815