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General NPI Number Information
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NPI Number | 1144748906
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Entity Type | Organization
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Legal Business Name | MOUNTAIN WEST ANESTHESIA PLLC
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 09/18/2017
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Provider Practice Location Address
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Address Line | 20940 N TATUM BLVD STE 100
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City | PHOENIX
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State | AZ
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Zip | 85050-7259
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Country | US
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Telephone | 480-502-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 6728 E GRANDVIEW DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-5668
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Country | US
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Telephone | 480-545-2610
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Fax | 480-545-2673
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | SORINA KING
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Credential |
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Telephone | 480-545-2610
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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 | CRNA0763
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License Number State | AZ
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