Healthcare Provider Details

I. General information

NPI: 1386850477
Provider Name (Legal Business Name): COCHISE GROUP ANESTHESIA SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CALLE PORTAL STE B260A
SIERRA VISTA AZ
85635-2967
US

IV. Provider business mailing address

77 CALLE PORTAL STE B260A
SIERRA VISTA AZ
85635-2967
US

V. Phone/Fax

Practice location:
  • Phone: 520-515-9751
  • Fax: 520-515-9786
Mailing address:
  • Phone: 520-515-9751
  • Fax: 520-515-9786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. MARTHA SUTTON
Title or Position: MEMBER
Credential:
Phone: 520-515-9751