Provider Demographics
NPI:1700836988
Name:MORPHEUS ANESTHESIA INC
Entity Type:Organization
Organization Name:MORPHEUS ANESTHESIA INC
Other - Org Name:STOCKTON ANESTHESIA MEDICAL GROUP, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUREK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-464-9846
Mailing Address - Street 1:2626 N CALIFORNIA ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5500
Mailing Address - Country:US
Mailing Address - Phone:209-464-9846
Mailing Address - Fax:209-464-4082
Practice Address - Street 1:2626 N CALIFORNIA ST
Practice Address - Street 2:SUITE G
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5500
Practice Address - Country:US
Practice Address - Phone:209-464-9846
Practice Address - Fax:209-464-4082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ32682ZMedicaid
CA6872615Medicaid
CAH94894Medicare UPIN
CAE92337Medicare UPIN
CAF48673Medicare UPIN
CAH57888Medicare UPIN
CAZZZ32682ZMedicaid
CAA93538Medicare UPIN
CA6872615Medicaid
CAH94084Medicare UPIN
CAG59274Medicare UPIN
CAE92339Medicare UPIN
CAH93539Medicare UPIN
CAZZZ32682ZMedicare PIN
CAE12833Medicare UPIN
CAE25215Medicare UPIN
CAB18122Medicare UPIN
CAC05200Medicare UPIN