Provider Demographics
NPI:1033276795
Name:RIDING ANESTHESIA LLC
Entity type:Organization
Organization Name:RIDING ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIDING
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:800-748-4868
Mailing Address - Street 1:1954 FORT UNION BLVD
Mailing Address - Street 2:101
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6800
Mailing Address - Country:US
Mailing Address - Phone:800-748-4868
Mailing Address - Fax:801-733-5872
Practice Address - Street 1:1220 E 3900 S
Practice Address - Street 2:4G
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1327
Practice Address - Country:US
Practice Address - Phone:800-748-4868
Practice Address - Fax:801-733-5872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty