Provider Demographics
NPI:1386667426
Name:EDIE J. AST C.R.N.A, LTD
Entity Type:Organization
Organization Name:EDIE J. AST C.R.N.A, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:AST
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:623-687-1717
Mailing Address - Street 1:20203 N CROWN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-3714
Mailing Address - Country:US
Mailing Address - Phone:623-687-1717
Mailing Address - Fax:623-584-9968
Practice Address - Street 1:20203 N CRWON RIDGE DR
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375
Practice Address - Country:US
Practice Address - Phone:623-687-1717
Practice Address - Fax:623-584-9968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMM9464Medicare ID - Type UnspecifiedMEDICARE B PROGRAM