Provider Demographics
NPI:1952623233
Name:MOUNTAIN HIGH ANESTHESIA PC
Entity Type:Organization
Organization Name:MOUNTAIN HIGH ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:505-410-4377
Mailing Address - Street 1:14820 72ND AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-4008
Mailing Address - Country:US
Mailing Address - Phone:425-582-9421
Mailing Address - Fax:425-967-7919
Practice Address - Street 1:14820 72ND AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-4008
Practice Address - Country:US
Practice Address - Phone:425-582-9421
Practice Address - Fax:425-967-7919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-27
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty