Provider Demographics
NPI:1588740971
Name:CERTIFIED ANESTHESIA SERVICES, LTD.
Entity type:Organization
Organization Name:CERTIFIED ANESTHESIA SERVICES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:928-474-4923
Mailing Address - Street 1:PO BOX 2358
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85547-2358
Mailing Address - Country:US
Mailing Address - Phone:928-472-2311
Mailing Address - Fax:928-472-9174
Practice Address - Street 1:807 S PONDEROSA ST
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5542
Practice Address - Country:US
Practice Address - Phone:928-472-1367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN059709367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ5877OtherJCG HEALTHNET
AZ1639255037OtherNPI
AZAZ0161970OtherPM BLUE CROSS BLUE SHIELD
AZAZ5785OtherWKM HEALTHNET
AZ750423Medicaid
AZAZ0163560OtherWM BLUE CROSS BLUE SHIELD
AZ18042985OtherWORKER'S COMP.
AZAZ0480270OtherJG BLUE CROSS BLUE SHIELD
AZ750431Medicaid
AZ750449Medicaid
AZAZ5790OtherPM HEALTHNET
AZ430068834Medicare PIN
AZAZ5785OtherWKM HEALTHNET
AZ750431Medicaid
AZ750449Medicaid
AZZRNA33441AMedicare PIN
AZAZ0161970OtherPM BLUE CROSS BLUE SHIELD