MEDICARE: ANESTHESIA OASIS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1407586332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANESTHESIA OASIS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 93358
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-3358
Country	:	US
Telephone Number	:	702-487-6510
Fax Number	:

Provider Business Practice Location Address
First Line	:	6362 MCLEOD DR STE 6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4433
Country	:	US
Telephone Number	:	702-487-6510
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	WILLIAM T AZZOLI
Credential	:	MD
Telephone Number	:	313-492-6961

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	06/14/2022

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