Basic Information
| Provider Information | |||||||||
| NPI: | 1518497882 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KINDRED ANESTHESIA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3317 SOUTH HIGLEY ROAD | ||||||||
| Address2: | STE 114, PMB | ||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024817369 | ||||||||
| FaxNumber: | 4804521464 | ||||||||
| Practice Location | |||||||||
| Address1: | 3782 S WHITE DR | ||||||||
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| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852860024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024817369 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2017 | ||||||||
| LastUpdateDate: | 10/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | BOWEN | ||||||||
| AuthorizedOfficialFirstName: | JEROD | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8016336696 | ||||||||
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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.