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NPI Code Detail

MEDICARE: NORTHEASTERN ANESTHESIA PLLC

MEDICARE: NORTHEASTERN ANESTHESIA PLLC
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
1207L00000XAnesthesiology Physician
2367500000XCertified Registered Nurse Anesthetist

General Provider Information

NPI Number : 1487956504
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHEASTERN ANESTHESIA PLLC
Provider Business Mailing Address
First Line : PO BOX 849955
Second Line :
City : LOS ANGELES
State : CA
Zip : 90084-9955
Country : US
Telephone Number : 877-747-5050
Fax Number : 775-747-5005
Provider Business Practice Location Address
First Line : 5700 E HIGHWAY 90
Second Line :
City : SIERRA VISTA
State : AZ
Zip : 85635-9110
Country : US
Telephone Number : 520-263-3835
Fax Number : 520-263-3919
Authorized Official
Title or Position : OWNER
Name : JOSEPH WILLIAM MARTIN
Credential : CRNA
Telephone Number : 559-289-4574
Provider Enumeration Date : 11/22/2010
Last Update Date : 03/17/2026

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Directions to “NORTHEASTERN ANESTHESIA PLLC ” Practice Location

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