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NPI Code Detail

MEDICARE: GREEN STATES ANESTHESIA PLLC

MEDICARE: GREEN STATES 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
11223D0004XDental Anesthesiology

General Provider Information

NPI Number : 1699252544
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREEN STATES ANESTHESIA PLLC
Provider Business Mailing Address
First Line : 3343 E INDIGO BAY CT
Second Line :
City : GILBERT
State : AZ
Zip : 85234-1737
Country : US
Telephone Number : 702-581-2819
Fax Number : 866-329-8262
Provider Business Practice Location Address
First Line : 1220 CARAWAY CT STE 1050
Second Line :
City : UPPER MARLBORO
State : MD
Zip : 20774-5338
Country : US
Telephone Number : 800-783-8584
Fax Number : 800-783-8584
Authorized Official
Title or Position : MANAGER
Name : NORA BRADY
Credential :
Telephone Number : 702-581-2819
Provider Enumeration Date : 07/24/2018
Last Update Date : 11/21/2022

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Directions to “GREEN STATES ANESTHESIA PLLC ” Practice Location

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