Provider Demographics
NPI:1265404024
Name:HAMMERHEAD ANESTHESIA INC
Entity type:Organization
Organization Name:HAMMERHEAD ANESTHESIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WERMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:928-537-4709
Mailing Address - Street 1:PO BOX 3703
Mailing Address - Street 2:
Mailing Address - City:PINETOP
Mailing Address - State:AZ
Mailing Address - Zip Code:85935-3703
Mailing Address - Country:US
Mailing Address - Phone:928-537-4709
Mailing Address - Fax:928-537-2466
Practice Address - Street 1:2200 E SHOW LOW LAKE RD
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7881
Practice Address - Country:US
Practice Address - Phone:928-537-4375
Practice Address - Fax:928-537-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty