Provider Demographics
NPI:1427342724
Name:HUALAPAI MOUNTAIN ANESTHESIA PLLC
Entity type:Organization
Organization Name:HUALAPAI MOUNTAIN ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-757-7976
Mailing Address - Street 1:3727 CERBAT VISTA DR
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-6950
Mailing Address - Country:US
Mailing Address - Phone:928-757-7976
Mailing Address - Fax:
Practice Address - Street 1:3801 SANTA ROSA DR
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-2311
Practice Address - Country:US
Practice Address - Phone:928-263-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty