MEDICARE: PIONEER ANESTHESIA GROUP INC

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	:	1619906310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIONEER ANESTHESIA GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 3750
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84110-3750
Country	:	US
Telephone Number	:	888-304-6796
Fax Number	:	801-432-2670

Provider Business Practice Location Address
First Line	:	3715 W 4100 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-5537
Country	:	US
Telephone Number	:	888-304-6796
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUDHA B SHAH
Credential	:	MD
Telephone Number	:	888-304-6796

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	09/14/2009

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