Provider Demographics
NPI:1699283614
Name:JG ANESTHESIA CONSULTING LLC
Entity type:Organization
Organization Name:JG ANESTHESIA CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GESTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DNAP, CRNA
Authorized Official - Phone:928-699-7306
Mailing Address - Street 1:2973 N KRISTIN DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-0964
Mailing Address - Country:US
Mailing Address - Phone:928-699-7306
Mailing Address - Fax:
Practice Address - Street 1:1020 N SAN FRANCISCO ST STE 200
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3281
Practice Address - Country:US
Practice Address - Phone:928-774-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty