Healthcare Provider Details

I. General information

NPI: 1639102197
Provider Name (Legal Business Name): PHOENIX ANESTHESIOLOGY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 COLUMBUS AVE
BAY CITY MI
48708
US

IV. Provider business mailing address

7 PARKWAY CTR STE 375
PITTSBURGH PA
15220
US

V. Phone/Fax

Practice location:
  • Phone: 989-894-3077
  • Fax: 989-894-6138
Mailing address:
  • Phone: 412-937-5700
  • Fax: 412-937-5739

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: DENNIS KEENE
Title or Position: PRESIDENT
Credential: MD
Phone: 989-893-9885