Provider Demographics
NPI:1568977114
Name:SOUTH VALLEY ANESTHESIA, LLC
Entity Type:Organization
Organization Name:SOUTH VALLEY ANESTHESIA, LLC
Other - Org Name:SOUTH VALLEY ANESTHESIA, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-868-2531
Mailing Address - Street 1:36453 N GANTZEL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-7340
Mailing Address - Country:US
Mailing Address - Phone:602-903-1527
Mailing Address - Fax:309-692-7226
Practice Address - Street 1:36453 N GANTZEL RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-7340
Practice Address - Country:US
Practice Address - Phone:480-652-3338
Practice Address - Fax:480-652-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty