Provider Demographics
NPI:1104023365
Name:SAFE ANESTHESIA MEDICAL GROUP
Entity Type:Organization
Organization Name:SAFE ANESTHESIA MEDICAL GROUP
Other - Org Name:WEST LOS ANGELES ANESTHESIA MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BROWNELL
Authorized Official - Middle Name:HILLARD
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-290-0725
Mailing Address - Street 1:269 S BEVERLY DR # 511
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3807
Mailing Address - Country:US
Mailing Address - Phone:323-290-0725
Mailing Address - Fax:323-290-0727
Practice Address - Street 1:2231 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1302
Practice Address - Country:US
Practice Address - Phone:323-290-0725
Practice Address - Fax:323-290-0727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26350207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty