MEDICARE: ADVANCED ANESTHESIA INCORPORATED

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	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1720543762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED ANESTHESIA INCORPORATED

Provider Business Mailing Address
First Line	:	PO BOX 34120
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89533-4120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9479 N FORT WASHINGTON RD STE 103
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93730-5939
Country	:	US
Telephone Number	:	559-289-4574
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH MARTIN
Credential	:	CRNA
Telephone Number	:	559-289-4574

Provider Enumeration Date	:	02/04/2019
Last Update Date	:	12/06/2023

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