Provider Demographics
NPI:1336819697
Name:ASCEND ANESTHESIA ASSOCIATES MT LLC
Entity Type:Organization
Organization Name:ASCEND ANESTHESIA ASSOCIATES MT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-874-7014
Mailing Address - Street 1:PO BOX 5870
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85211-5870
Mailing Address - Country:US
Mailing Address - Phone:480-874-7014
Mailing Address - Fax:480-874-7015
Practice Address - Street 1:4802 E RAY RD STE E23-273
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6405
Practice Address - Country:US
Practice Address - Phone:480-874-7014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty