Provider Demographics
NPI:1417066192
Name:PARADISE ANESTHESIA ASSOCIATES
Entity Type:Organization
Organization Name:PARADISE ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TI MOTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GLEASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-243-0440
Mailing Address - Street 1:PO BOX 492680
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-2680
Mailing Address - Country:US
Mailing Address - Phone:530-243-0440
Mailing Address - Fax:530-243-0445
Practice Address - Street 1:5974 PENTZ RD
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5509
Practice Address - Country:US
Practice Address - Phone:530-877-9361
Practice Address - Fax:530-243-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ20133ZMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER