Healthcare Provider Details

I. General information

NPI: 1053980771
Provider Name (Legal Business Name): PINNACLE WEST ANESTHESIA SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2373 G RD STE 180
GRAND JUNCTION CO
81505-1003
US

IV. Provider business mailing address

PO BOX 292817
NASHVILLE TN
37229-2817
US

V. Phone/Fax

Practice location:
  • Phone: 615-620-2320
  • Fax:
Mailing address:
  • Phone: 615-620-2320
  • Fax: 615-620-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: BRAD KELLER
Title or Position: CRNA/OWNER
Credential: CRNA
Phone: 615-620-2320