Healthcare Provider Details

I. General information

NPI: 1659922201
Provider Name (Legal Business Name): HATTON ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9709 E 79TH ST
TULSA OK
74133-4566
US

IV. Provider business mailing address

PO BOX 70
LAKE BLUFF IL
60044-0070
US

V. Phone/Fax

Practice location:
  • Phone: 918-994-4000
  • Fax:
Mailing address:
  • Phone: 800-444-6110
  • Fax: 847-615-2858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRANDON K HATTON
Title or Position: OWNER
Credential: CRNA
Phone: 800-444-6110