Provider Demographics
NPI:1487083028
Name:SAN PEDRO ANESTHESIA, PLLC
Entity type:Organization
Organization Name:SAN PEDRO ANESTHESIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-226-4338
Mailing Address - Street 1:77 CALLE PORTAL
Mailing Address - Street 2:SUITE B260A
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2967
Mailing Address - Country:US
Mailing Address - Phone:520-226-4338
Mailing Address - Fax:866-479-4841
Practice Address - Street 1:77 CALLE PORTAL
Practice Address - Street 2:SUITE B260A
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2967
Practice Address - Country:US
Practice Address - Phone:520-226-4338
Practice Address - Fax:866-479-4841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty