Provider Demographics
NPI:1033385414
Name:AVALOS ANESTHESIA SERVICES INC.
Entity Type:Organization
Organization Name:AVALOS ANESTHESIA SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:AVALOS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:928-368-8118
Mailing Address - Street 1:580 BLACK HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CLARKDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:86324-3734
Mailing Address - Country:US
Mailing Address - Phone:928-368-8118
Mailing Address - Fax:928-368-8121
Practice Address - Street 1:651 W MINGUS AVE STE 2A
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4017
Practice Address - Country:US
Practice Address - Phone:928-649-4480
Practice Address - Fax:928-634-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ18262367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ750316Medicaid
AZ750316Medicaid
AZPENDINGMedicare PIN