Provider Demographics
NPI:1235391657
Name:MARANATHA ANESTHESIA, PLLC
Entity Type:Organization
Organization Name:MARANATHA ANESTHESIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATUTORY AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-512-3970
Mailing Address - Street 1:1500 S DOBSON RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4713
Mailing Address - Country:US
Mailing Address - Phone:480-512-3970
Mailing Address - Fax:480-512-5486
Practice Address - Street 1:1500 S DOBSON RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4713
Practice Address - Country:US
Practice Address - Phone:480-512-3970
Practice Address - Fax:480-512-5486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21508207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty