Provider Demographics
NPI:1881040046
Name:ADVANCED ANESTHESIA, PLC
Entity Type:Organization
Organization Name:ADVANCED ANESTHESIA, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDI
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUNDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-535-9777
Mailing Address - Street 1:3400 N DYSART RD
Mailing Address - Street 2:H-131
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-1003
Mailing Address - Country:US
Mailing Address - Phone:623-535-9777
Mailing Address - Fax:623-236-3179
Practice Address - Street 1:3400 N DYSART RD
Practice Address - Street 2:H-131
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-1003
Practice Address - Country:US
Practice Address - Phone:623-535-9777
Practice Address - Fax:623-236-3179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicaid
AZPENDINGMedicare PIN