Provider Demographics
NPI:1841439361
Name:ANESTHESIA IAG SERVICES LT
Entity type:Organization
Organization Name:ANESTHESIA IAG SERVICES LT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ULSHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:760-241-2179
Mailing Address - Street 1:13332 CABANA WAY
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-6364
Mailing Address - Country:US
Mailing Address - Phone:760-241-2179
Mailing Address - Fax:
Practice Address - Street 1:13332 CABANA WAY
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-6364
Practice Address - Country:US
Practice Address - Phone:760-241-2179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN299944 CRNA 604367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist AssistantGroup - Single Specialty