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General NPI Number Information
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NPI Number | 1053980771
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Entity Type | Organization
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Legal Business Name | PINNACLE WEST ANESTHESIA SERVICES, LLC
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Dates
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Enumeration Date | 06/18/2021
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 2373 G RD STE 180
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City | GRAND JUNCTION
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State | CO
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Zip | 81505-1003
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Country | US
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Telephone | 615-620-2320
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 292817
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City | NASHVILLE
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State | TN
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Zip | 37229-2817
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Country | US
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Telephone | 615-620-2320
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Fax | 615-620-2323
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Authorized Official
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Title or Position | CRNA/OWNER
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Name | BRAD KELLER
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Credential | CRNA
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Telephone | 615-620-2320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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