Basic Information
| Provider Information | |||||||||
| NPI: | 1043619158 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ZIA AMBULATORY ANESTHESIA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4401 MASTHEAD ST NE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871094493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052437729 | ||||||||
| FaxNumber: | 5052434804 | ||||||||
| Practice Location | |||||||||
| Address1: | 4401 MASTHEAD ST NE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871094493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052437729 | ||||||||
| FaxNumber: | 5052434804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2014 | ||||||||
| LastUpdateDate: | 08/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | BUSICK | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5052437729 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.