Basic Information
| Provider Information | |||||||||
| NPI: | 1467013987 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTERN ANESTHESIA, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 S MCCLINTOCK DR STE 100 | ||||||||
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| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852264816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024817369 | ||||||||
| FaxNumber: | 4804521464 | ||||||||
| Practice Location | |||||||||
| Address1: | 1464 E WHITESTONE BLVD STE 601 | ||||||||
| Address2: | |||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786139066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5127721677 | ||||||||
| FaxNumber: | 5127721692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2019 | ||||||||
| LastUpdateDate: | 06/25/2019 | ||||||||
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| AuthorizedOfficialLastName: | RUDD | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF RCM | ||||||||
| AuthorizedOfficialTelephone: | 6025407992 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.