Provider Demographics
NPI:1316040769
Name:SANTA CRUZ ANESTHESIA ASSOCIATES
Entity Type:Organization
Organization Name:SANTA CRUZ ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:520-287-4020
Mailing Address - Street 1:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85628-0819
Mailing Address - Country:US
Mailing Address - Phone:520-287-4020
Mailing Address - Fax:520-287-2348
Practice Address - Street 1:1209 W TARGET RANGE ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621
Practice Address - Country:US
Practice Address - Phone:520-287-4020
Practice Address - Fax:520-287-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ121848Medicaid
AZ121848Medicaid
X45802Medicare UPIN