Provider Demographics
NPI:1376690966
Name:ANESTHESIA AND INTENSIVE CARE SPECIALISTS LLP
Entity Type:Organization
Organization Name:ANESTHESIA AND INTENSIVE CARE SPECIALISTS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-686-9347
Mailing Address - Street 1:6130 ELTON AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2538
Mailing Address - Country:US
Mailing Address - Phone:702-476-0297
Mailing Address - Fax:188-834-0242
Practice Address - Street 1:6130 ELTON AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2538
Practice Address - Country:US
Practice Address - Phone:702-476-0297
Practice Address - Fax:888-340-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV103609Medicare PIN