Healthcare Provider Details

I. General information

NPI: 1043744733
Provider Name (Legal Business Name): THS ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3329 E BELL RD STE A1-A5
PHOENIX AZ
85032-2756
US

IV. Provider business mailing address

3329 E BELL RD STE A1-A5
PHOENIX AZ
85032-2756
US

V. Phone/Fax

Practice location:
  • Phone: 602-482-2282
  • Fax:
Mailing address:
  • Phone: 602-482-2282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIN L WAYCHOFF
Title or Position: SOLE MBR
Credential: DC
Phone: 602-482-2282