Provider Demographics
NPI: | 1568143469 |
---|---|
Name: | ASPEN ANESTHESIA SERVICES PAIN EXPERTS AND NURSING NETWORKS INC |
Entity Type: | Organization |
Organization Name: | ASPEN ANESTHESIA SERVICES PAIN EXPERTS AND NURSING NETWORKS INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF FINANCIAL OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KELLY |
Authorized Official - Middle Name: | KAIULANI |
Authorized Official - Last Name: | NORRIS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | CRNA |
Authorized Official - Phone: | 509-389-3299 |
Mailing Address - Street 1: | 4270 WILBUR CT |
Mailing Address - Street 2: | |
Mailing Address - City: | HEMET |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92544-1892 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 870-897-1774 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4270 WILBUR CT |
Practice Address - Street 2: | |
Practice Address - City: | HEMET |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92544-1892 |
Practice Address - Country: | US |
Practice Address - Phone: | 870-897-1774 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-07-25 |
Last Update Date: | 2023-11-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty |