Healthcare Provider Details

I. General information

NPI: 1437725629
Provider Name (Legal Business Name): FH ANESTHESIA GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5133 N CENTRAL AVE STE 110
PHOENIX AZ
85012-1438
US

IV. Provider business mailing address

5133 N CENTRAL AVE STE 110
PHOENIX AZ
85012-1438
US

V. Phone/Fax

Practice location:
  • Phone: 505-506-0737
  • Fax:
Mailing address:
  • Phone: 505-506-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DON BACA
Title or Position: MANAGER
Credential:
Phone: 505-506-0737