Healthcare Provider Details

I. General information

NPI: 1710450143
Provider Name (Legal Business Name): TIPTON ANESTHESIA, A PROFESSIONAL ANESTHESIA NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 COLORADO AVE STE 140
TURLOCK CA
95382-2711
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267-0096
US

V. Phone/Fax

Practice location:
  • Phone: 209-216-3470
  • Fax: 209-216-3475
Mailing address:
  • Phone: 209-956-7725
  • Fax: 209-956-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAY TIPTON
Title or Position: CRNA / OWNER
Credential: CRNA
Phone: 209-216-3470