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General NPI Number Information
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NPI Number | 1568977114
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Entity Type | Organization
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Legal Business Name | SOUTH VALLEY ANESTHESIA, LLC
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Dates
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Enumeration Date | 12/05/2017
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Last Update Date | 12/26/2019
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Provider Practice Location Address
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Address Line | 36453 N GANTZEL RD STE 101
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85140-7340
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Country | US
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Telephone | 480-652-3338
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Fax | 480-652-3338
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Provider Business Mailing Address
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Address Line | 36453 N GANTZEL RD STE 101
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85140-7340
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Country | US
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Telephone | 602-903-1527
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Fax | 309-692-7226
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | KEVIN HENRY
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Credential | MD
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Telephone | 309-868-2531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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