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General NPI Number Information
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NPI Number | 1477081792
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Entity Type | Organization
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Legal Business Name | MAGNUM ANESTHESIA, LLC
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3724 N 3RD ST STE 301
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City | PHOENIX
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State | AZ
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Zip | 85012-2035
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Country | US
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Telephone | 480-634-6400
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Fax | 480-404-9649
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Provider Business Mailing Address
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Address Line | 3724 N 3RD ST STE 301
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City | PHOENIX
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State | AZ
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Zip | 85012-2035
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Country | US
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Telephone | 480-634-6400
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Fax | 480-404-9649
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Authorized Official
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Title or Position | COO / MANAGER
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Name | CHALLEN WAYCHOFF III
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Credential |
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Telephone | 760-486-9634
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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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