Provider Demographics
NPI:1871507293
Name:ANESTHESIA CONSULTANTS OF SACRAMENTO A MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ANESTHESIA CONSULTANTS OF SACRAMENTO A MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KIP
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-481-6800
Mailing Address - Street 1:PO BOX 660908
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95866-0908
Mailing Address - Country:US
Mailing Address - Phone:916-481-6800
Mailing Address - Fax:916-481-1881
Practice Address - Street 1:3315 WATT AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-3600
Practice Address - Country:US
Practice Address - Phone:916-481-6800
Practice Address - Fax:916-481-1881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37098001207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0046250Medicaid
CAZZZ25666ZMedicare ID - Type Unspecified