Healthcare Provider Details

I. General information

NPI: 1386003754
Provider Name (Legal Business Name): VYAS ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 E SOUTHERN AVE SUITE 1
TEMPE AZ
85282
US

IV. Provider business mailing address

PO BOX 41150
MESA AZ
85274
US

V. Phone/Fax

Practice location:
  • Phone: 480-425-2160
  • Fax: 480-351-8797
Mailing address:
  • Phone: 480-425-2160
  • Fax: 480-351-8797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number44011
License Number StateAZ

VIII. Authorized Official

Name: BHAVIN ANIL VYAS
Title or Position: PHYSICIAN
Credential: MD
Phone: 480-425-2160