=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861449423
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METROPOLITAN ANESTHESIA CONSULTANTS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2006
-----------------------------------------------------
Last Update Date | 03/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2288 AUBURN BLVD
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-929-7229
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5530 BIRDCAGE ST STE 145
-----------------------------------------------------
City | CITRUS HEIGHTS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-956-7725
-----------------------------------------------------
Fax | 209-956-7733
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GROUP PRESIDENT
-----------------------------------------------------
Name | MELVIN NUNN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 916-929-7229
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------