Provider Demographics
NPI:1043745458
Name:ALPHA ONE ANESTHESIA LLC
Entity Type:Organization
Organization Name:ALPHA ONE ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-416-3705
Mailing Address - Street 1:PO BOX 11180
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-0020
Mailing Address - Country:US
Mailing Address - Phone:949-416-3705
Mailing Address - Fax:
Practice Address - Street 1:1001 E WARNER RD
Practice Address - Street 2:SUITE 103
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3224
Practice Address - Country:US
Practice Address - Phone:949-416-3705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-23
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty