Healthcare Provider Details

I. General information

NPI: 1790010239
Provider Name (Legal Business Name): STIMPSON ANESTHESIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4364 WASHINGTON BLVD
OGDEN UT
84403-1866
US

IV. Provider business mailing address

4364 WASHINGTON BLVD
OGDEN UT
84403-1866
US

V. Phone/Fax

Practice location:
  • Phone: 801-781-4000
  • Fax:
Mailing address:
  • Phone: 801-781-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4758542
License Number StateUT

VIII. Authorized Official

Name: JAMES ROBERT STIMPSON
Title or Position: PRESIDENT
Credential: CRNA
Phone: 801-791-9566