Provider Demographics
NPI:1396181392
Name:GLOBAL MOBILE ANESTHESIA LLC
Entity Type:Organization
Organization Name:GLOBAL MOBILE ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAVCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-909-8791
Mailing Address - Street 1:16620 N 40TH ST
Mailing Address - Street 2:SUITE D1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3348
Mailing Address - Country:US
Mailing Address - Phone:602-819-2038
Mailing Address - Fax:
Practice Address - Street 1:16620 N 40TH ST
Practice Address - Street 2:SUITE D1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3348
Practice Address - Country:US
Practice Address - Phone:602-819-2038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLOBAL ANESTHESIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ697478Medicare UPIN
AZZ123472Medicare PIN