Basic Information
| Provider Information | |||||||||
| NPI: | 1609800309 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DESERT MOUNTAIN CONSULTANTS IN ANESTHESIA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8970 E RAINTREE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852607300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806099300 | ||||||||
| FaxNumber: | 4806099350 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 E DUNLAP AVE | ||||||||
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| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850202825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022739333 | ||||||||
| FaxNumber: | 4806099350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 03/07/2017 | ||||||||
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| AuthorizedOfficialLastName: | COWARD | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9549395000 | ||||||||
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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.