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General NPI Number Information
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NPI Number | 1124422183
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Entity Type | Organization
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Legal Business Name | ENDOSCOPY ANESTHESIA SERVICE, PLLC
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 12361 W BOLA DR STE 107
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City | SURPRISE
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State | AZ
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Zip | 85378-9021
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Country | US
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Telephone | 623-332-1441
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Fax | 623-974-9741
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Provider Business Mailing Address
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Address Line | 4808 N 24TH ST UNIT 1201
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City | PHOENIX
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State | AZ
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Zip | 85016-9114
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Country | US
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Telephone | 623-332-1441
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Fax | 623-974-9741
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Authorized Official
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Title or Position | MANAGER
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Name | DR. THINH KIM LE
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Credential | MD
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Telephone | 623-332-1441
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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 | 31542
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License Number State | AZ
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