Provider Demographics
NPI:1346851276
Name:GALAXY ANESTHESIA SERVICES, LLC
Entity Type:Organization
Organization Name:GALAXY ANESTHESIA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGART
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:623-230-2912
Mailing Address - Street 1:7558 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 1-623
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4836
Mailing Address - Country:US
Mailing Address - Phone:623-230-2912
Mailing Address - Fax:
Practice Address - Street 1:13660 N 94TH DR
Practice Address - Street 2:D-1
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-8538
Practice Address - Country:US
Practice Address - Phone:623-230-2912
Practice Address - Fax:602-726-3605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric AnesthesiologyGroup - Single Specialty