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General NPI Number Information
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NPI Number | 1750945507
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Entity Type | Organization
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Legal Business Name | LEGACY ANESTHESIA LLC
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Dates
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Enumeration Date | 04/26/2019
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 9377 E BELL RD STE 201
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-1503
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Country | US
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Telephone | 701-741-4879
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3273
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City | IDAHO FALLS
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State | ID
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Zip | 83403-3273
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Country | US
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Telephone | 208-525-2090
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Fax | 208-523-8978
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MR. SHAUN KENNETH FERRIE
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Credential | CRNA
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Telephone | 480-209-4000
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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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