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General NPI Number Information
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NPI Number | 1700147832
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Entity Type | Organization
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Legal Business Name | KEYSTONE ANESTHESIA MOBILE, PLC
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Dates
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Enumeration Date | 06/05/2012
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Last Update Date | 06/05/2012
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Provider Practice Location Address
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Address Line | 6721 N COCOPAS RD
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City | TUCSON
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State | AZ
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Zip | 85718-2533
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Country | US
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Telephone | 623-523-9735
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Fax |
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Provider Business Mailing Address
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Address Line | 6721 N COCOPAS RD
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City | TUCSON
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State | AZ
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Zip | 85718-2533
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Country | US
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Telephone | 623-523-9735
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | VENKATESH NARA
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Credential | M.D.
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Telephone | 623-523-9735
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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 | 32171
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License Number State | AZ
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