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General NPI Number Information
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NPI Number | 1861560351
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Entity Type | Organization
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Legal Business Name | GREAT BASIN ANESTHESIA
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1600 W ANTELOPE DR
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City | LAYTON
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State | UT
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Zip | 84041-1142
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Country | US
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Telephone | 801-547-0202
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 856
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City | KAYSVILLE
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State | UT
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Zip | 84037-0856
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Country | US
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Telephone | 801-547-0202
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. WALTER A NEWLIN
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Credential | CRNA
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Telephone | 801-547-0202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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