Healthcare Provider Details

I. General information

NPI: 1134352925
Provider Name (Legal Business Name): SQUAW PEAK ANESTHESIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E BAYVIEW DR
TEMPE AZ
85283-2170
US

IV. Provider business mailing address

PO BOX 81024
PHOENIX AZ
85069-1024
US

V. Phone/Fax

Practice location:
  • Phone: 602-300-6383
  • Fax: 602-467-4721
Mailing address:
  • Phone: 602-371-4973
  • Fax: 602-467-4721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN060004
License Number StateAZ

VIII. Authorized Official

Name: MS. MAUREEN B RILEY
Title or Position: PRESIDENT
Credential: CRNA, BSN, MAE
Phone: 602-371-4973