Provider Demographics
NPI:1720855083
Name:MOBILE ANESTHESIA PROVIDERS
Entity Type:Organization
Organization Name:MOBILE ANESTHESIA PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:N/A
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-407-1744
Mailing Address - Street 1:1254 W UNIVERSITY AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-7217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1254 W UNIVERSITY AVE STE 130
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-7217
Practice Address - Country:US
Practice Address - Phone:800-407-1744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty