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General NPI Number Information
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NPI Number | 1720386832
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Entity Type | Organization
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Legal Business Name | MESA ANESTHESIA SERVICES PLLC
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Dates
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Enumeration Date | 03/14/2011
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Last Update Date | 03/14/2011
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Provider Practice Location Address
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Address Line | 8573 E PRINCESS DR SUITE 215
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-7819
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Country | US
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Telephone | 480-563-5757
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4860
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City | MURRELLS INLET
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State | SC
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Zip | 29576-2698
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Country | US
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Telephone | 843-651-2624
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Fax | 843-357-4940
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. MICHAEL T MITCHELL
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Credential |
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Telephone | 480-563-5757
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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 |
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License Number State |
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Taxonomy #2
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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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