Provider Demographics
NPI:1386850477
Name:COCHISE GROUP ANESTHESIA SERVICES, LLC
Entity Type:Organization
Organization Name:COCHISE GROUP ANESTHESIA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-515-9751
Mailing Address - Street 1:77 CALLE PORTAL STE B260A
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2967
Mailing Address - Country:US
Mailing Address - Phone:520-515-9751
Mailing Address - Fax:520-515-9786
Practice Address - Street 1:77 CALLE PORTAL STE B260A
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2967
Practice Address - Country:US
Practice Address - Phone:520-515-9751
Practice Address - Fax:520-515-9786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZWDBPNMedicare PIN