MEDICARE: OPHTHALMIC ANESTHESIOLOGY CONSULTANTS OF ARIZONA 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
1	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1598277832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPHTHALMIC ANESTHESIOLOGY CONSULTANTS OF ARIZONA PLLC

Provider Business Mailing Address
First Line	:	7878 N 16TH ST STE 250
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4478
Country	:	US
Telephone Number	:	602-395-0718
Fax Number	:	602-277-8146

Provider Business Practice Location Address
First Line	:	7878 N 16TH ST STE 250
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4478
Country	:	US
Telephone Number	:	602-395-0718
Fax Number	:	602-277-8146

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR/DIRECTOR
Name	:	CHARLES L SHIRLEY
Credential	:
Telephone Number	:	602-308-7809

Provider Enumeration Date	:	10/26/2017
Last Update Date	:	01/16/2018

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