Basic Information
| Provider Information | |||||||||
| NPI: | 1568005221 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMIT ANESTHESIA PARTNERS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3724 W ASHTON CT | ||||||||
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| City: | ANTHEM | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850862761 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3929 E BELL RD | ||||||||
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| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850322112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029235000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2019 | ||||||||
| LastUpdateDate: | 02/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | KUZMIAK | ||||||||
| AuthorizedOfficialFirstName: | ADAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | GENERAL PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 4807731803 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
| NPICertificationDate: | 02/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 367500000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.