Provider Demographics
NPI:1184662884
Name:ABC ANESTHESIOLOGISTS PLLC
Entity Type:Organization
Organization Name:ABC ANESTHESIOLOGISTS PLLC
Other - Org Name:RED MOUNTAIN ANESTHESIOLOGISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-418-6687
Mailing Address - Street 1:8405 E VISTA CANYON CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-1469
Mailing Address - Country:US
Mailing Address - Phone:602-418-6687
Mailing Address - Fax:480-503-0896
Practice Address - Street 1:8405 E VISTA CANYON CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-1469
Practice Address - Country:US
Practice Address - Phone:602-418-6687
Practice Address - Fax:480-503-0896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X
AZ207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ518318Medicaid
AZ518318Medicaid