Provider Demographics
NPI:1124422183
Name:ENDOSCOPY ANESTHESIA SERVICE, PLLC
Entity type:Organization
Organization Name:ENDOSCOPY ANESTHESIA SERVICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:THINH
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-332-1441
Mailing Address - Street 1:4808 N 24TH ST UNIT 1201
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-9114
Mailing Address - Country:US
Mailing Address - Phone:623-332-1441
Mailing Address - Fax:623-974-9741
Practice Address - Street 1:12361 W BOLA DR STE 107
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9021
Practice Address - Country:US
Practice Address - Phone:623-332-1441
Practice Address - Fax:623-974-9741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31542207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty