Healthcare Provider Details

I. General information

NPI: 1003458704
Provider Name (Legal Business Name): ANESTHESIA MANAGEMENT SERVICES OF CALIFORNIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HOSPITAL DR
UKIAH CA
95482-4531
US

IV. Provider business mailing address

PO BOX 34120
RENO NV
89533-4120
US

V. Phone/Fax

Practice location:
  • Phone: 707-463-3111
  • Fax: 707-463-7339
Mailing address:
  • Phone: 775-747-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL THIBODEAUX
Title or Position: PRESIDENT
Credential:
Phone: 319-331-0621