Provider Demographics
NPI: | 1033276795 |
---|---|
Name: | RIDING ANESTHESIA LLC |
Entity Type: | Organization |
Organization Name: | RIDING ANESTHESIA LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | WAYNE |
Authorized Official - Middle Name: | R |
Authorized Official - Last Name: | RIDING |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | CRNA |
Authorized Official - Phone: | 800-748-4868 |
Mailing Address - Street 1: | 1954 FORT UNION BLVD |
Mailing Address - Street 2: | 101 |
Mailing Address - City: | SALT LAKE CITY |
Mailing Address - State: | UT |
Mailing Address - Zip Code: | 84121-6800 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-748-4868 |
Mailing Address - Fax: | 801-733-5872 |
Practice Address - Street 1: | 1220 E 3900 S |
Practice Address - Street 2: | 4G |
Practice Address - City: | SALT LAKE CITY |
Practice Address - State: | UT |
Practice Address - Zip Code: | 84124-1327 |
Practice Address - Country: | US |
Practice Address - Phone: | 800-748-4868 |
Practice Address - Fax: | 801-733-5872 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-01-02 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Single Specialty |