Provider Demographics
NPI:1285101824
Name:16TH STREET ANESTHESIA SERVICES CORP
Entity type:Organization
Organization Name:16TH STREET ANESTHESIA SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAZILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-395-1335
Mailing Address - Street 1:2323 16TH ST STE 507
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3454
Mailing Address - Country:US
Mailing Address - Phone:661-395-1335
Mailing Address - Fax:
Practice Address - Street 1:2323 16TH ST STE 507
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3454
Practice Address - Country:US
Practice Address - Phone:661-395-1335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty