Healthcare Provider Details

I. General information

NPI: 1659559367
Provider Name (Legal Business Name): ANESTHESIA CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 E 700 S STE 10B
ST GEORGE UT
84770-4036
US

IV. Provider business mailing address

PO BOX 911928
ST GEORGE UT
84791-1928
US

V. Phone/Fax

Practice location:
  • Phone: 435-652-9127
  • Fax: 435-674-7339
Mailing address:
  • Phone: 435-652-9127
  • Fax: 435-674-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number1845581205
License Number StateUT

VIII. Authorized Official

Name: BRUCE M CARTER
Title or Position: PRESIDENT
Credential: MD
Phone: 435-652-9127