Healthcare Provider Details

I. General information

NPI: 1043619158
Provider Name (Legal Business Name): ZIA AMBULATORY ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 MASTHEAD ST NE SUITE 120
ALBUQUERQUE NM
87109-4493
US

IV. Provider business mailing address

4401 MASTHEAD ST NE SUITE 120
ALBUQUERQUE NM
87109-4493
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-7729
  • Fax: 505-243-4804
Mailing address:
  • Phone: 505-243-7729
  • Fax: 505-243-4804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. LINDA J BUSICK
Title or Position: OFFICE MANAGER
Credential:
Phone: 505-243-7729