Provider Demographics
NPI:1598122962
Name:UNITED ANESTHESIA CONSULTANTS LLC
Entity Type:Organization
Organization Name:UNITED ANESTHESIA CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-507-2961
Mailing Address - Street 1:4566 E VIA LOS CABALLOS
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6140
Mailing Address - Country:US
Mailing Address - Phone:602-740-1282
Mailing Address - Fax:
Practice Address - Street 1:4022 E GREENWAY RD
Practice Address - Street 2:STE 2
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4797
Practice Address - Country:US
Practice Address - Phone:602-795-0207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37949207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty