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General NPI Number Information
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NPI Number | 1003458704
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Entity Type | Organization
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Legal Business Name | ANESTHESIA MANAGEMENT SERVICES OF CALIFORNIA INC
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Dates
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Enumeration Date | 10/14/2019
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Last Update Date | 10/14/2019
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Provider Practice Location Address
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Address Line | 275 HOSPITAL DR
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City | UKIAH
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State | CA
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Zip | 95482-4531
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Country | US
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Telephone | 707-463-3111
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Fax | 707-463-7339
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Provider Business Mailing Address
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Address Line | PO BOX 34120
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City | RENO
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State | NV
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Zip | 89533-4120
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Country | US
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Telephone | 775-747-5050
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMUEL THIBODEAUX
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Credential |
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Telephone | 319-331-0621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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