Healthcare Provider Details

I. General information

NPI: 1760082184
Provider Name (Legal Business Name): ASAP ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W GREENWAY RD STE 125
PHOENIX AZ
85023-4226
US

IV. Provider business mailing address

2525 W GREENWAY RD STE 125
PHOENIX AZ
85023-4226
US

V. Phone/Fax

Practice location:
  • Phone: 480-573-0130
  • Fax: 480-573-0131
Mailing address:
  • Phone: 480-573-0130
  • Fax: 480-573-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KEITH RICKER
Title or Position: MANAGER
Credential:
Phone: 480-573-0130