Provider Demographics
NPI:1316308059
Name:SOUTHWEST ANESTHESIA SERVICES LLC
Entity type:Organization
Organization Name:SOUTHWEST ANESTHESIA SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:FAYBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-545-6060
Mailing Address - Street 1:2223 E BASELINE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2325
Mailing Address - Country:US
Mailing Address - Phone:480-289-5266
Mailing Address - Fax:480-289-5271
Practice Address - Street 1:2223 E BASELINE RD
Practice Address - Street 2:SUITE B
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2325
Practice Address - Country:US
Practice Address - Phone:480-289-5266
Practice Address - Fax:480-289-5271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center