Basic Information
| Provider Information | |||||||||
| NPI: | 1548409451 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN GIRL ANESTHESIA SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 295 | ||||||||
| Address2: | |||||||||
| City: | SNOWFLAKE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859370295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283688118 | ||||||||
| FaxNumber: | 9283688121 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 E SHOW LOW LAKE RD | ||||||||
| Address2: | |||||||||
| City: | SHOW LOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859017831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283688118 | ||||||||
| FaxNumber: | 9283688121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2009 | ||||||||
| LastUpdateDate: | 03/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | KEMPER | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9283688118 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | PENDING | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.