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General NPI Number Information
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NPI Number | 1104023365
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Entity Type | Organization
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Legal Business Name | SAFE ANESTHESIA MEDICAL GROUP
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2231 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90018-1302
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Country | US
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Telephone | 323-290-0725
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Fax | 323-290-0727
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Provider Business Mailing Address
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Address Line | 269 S BEVERLY DR # 511
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-3807
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Country | US
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Telephone | 323-290-0725
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Fax | 323-290-0727
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. BROWNELL HILLARD PAYNE
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Credential | M.D.
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Telephone | 323-290-0725
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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 | A26350
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License Number State | CA
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