Provider Demographics
NPI:1295790384
Name:BRIGHAM ANESTHESIA SPECIALISTS LTD
Entity type:Organization
Organization Name:BRIGHAM ANESTHESIA SPECIALISTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SALTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-882-2106
Mailing Address - Street 1:PO BOX 15151
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85060-5151
Mailing Address - Country:US
Mailing Address - Phone:602-882-2106
Mailing Address - Fax:
Practice Address - Street 1:1111 E MCDOWELL ROAD
Practice Address - Street 2:BANNER GOOD SAMARITAN REGIONAL MEDICAL CENTER
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-239-2147
Practice Address - Fax:602-239-2581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9138207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ227050OtherAHCCCS
AZ227050OtherAHCCCS
D44451Medicare UPIN