Provider Demographics
NPI:1619217320
Name:ANESTHESIA MEDICAL GRP OF SO CA, INC.
Entity Type:Organization
Organization Name:ANESTHESIA MEDICAL GRP OF SO CA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BEUTTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-473-6555
Mailing Address - Street 1:2590 E MAIN ST
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2619
Mailing Address - Country:US
Mailing Address - Phone:805-643-3030
Mailing Address - Fax:805-643-3036
Practice Address - Street 1:227 W JANSS RD
Practice Address - Street 2:SUITE #240
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1848
Practice Address - Country:US
Practice Address - Phone:805-371-0455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-18
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGMedicaid
CAPENDINGMedicare PIN