Healthcare Provider Details

I. General information

NPI: 1992037113
Provider Name (Legal Business Name): SIERRA VISTA GROUP ANESTHESIA SERVICES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

77 CALLE PORTAL STE B260A SUITE 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:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number13713
License Number StateAZ

VIII. Authorized Official

Name: JAMES BUTTKE
Title or Position: PRESIDENT
Credential: MD
Phone: 520-515-9751