Provider Demographics
NPI:1568856318
Name:WSR ANESTHESIA PLLC
Entity Type:Organization
Organization Name:WSR ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGILL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:480-813-6309
Mailing Address - Street 1:PO BOX 1240
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85244-1240
Mailing Address - Country:US
Mailing Address - Phone:480-813-6309
Mailing Address - Fax:480-813-8344
Practice Address - Street 1:24 W GARY AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-1512
Practice Address - Country:US
Practice Address - Phone:480-813-6309
Practice Address - Fax:480-813-8344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ89310174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700156528OtherINDIVIDUAL NPI