Provider Demographics
NPI:1134447162
Name:MILKY WAY ANESTHESIA LLC
Entity type:Organization
Organization Name:MILKY WAY ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUELAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-393-9103
Mailing Address - Street 1:10255 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3851
Mailing Address - Country:US
Mailing Address - Phone:602-393-9103
Mailing Address - Fax:
Practice Address - Street 1:10255 N 32ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3851
Practice Address - Country:US
Practice Address - Phone:602-393-9103
Practice Address - Fax:602-254-3474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty