Healthcare Provider Details

I. General information

NPI: 1710069406
Provider Name (Legal Business Name): MADIGAN ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 N 900 E
AMERICAN FORK UT
84003-9183
US

IV. Provider business mailing address

PO BOX 3750
SALT LAKE CITY UT
84110-3750
US

V. Phone/Fax

Practice location:
  • Phone: 801-432-2640
  • Fax: 801-432-2670
Mailing address:
  • Phone: 801-432-2640
  • Fax: 801-432-2670

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: KAREN MADIGAN
Title or Position: PRESIDENT
Credential: CRNA
Phone: 801-432-2640