=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598235376
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANITA R RAMAIAH MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2018
-----------------------------------------------------
Last Update Date | 12/05/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 E MCDOWELL RD
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85006-2612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-839-4262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12991 N 130TH WAY
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85259-3548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-600-0600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | ANITA R RAMAIAH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 480-600-0600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------