Basic Information
| Provider Information | |||||||||
| NPI: | 1831560176 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CAMELBACK ANESTHESIA PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CAMELBACK PAIN CONSULTANTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2421 E SOUTHERN AVE | ||||||||
| Address2: | STE 1 | ||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852827612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804252160 | ||||||||
| FaxNumber: | 4803518797 | ||||||||
| Practice Location | |||||||||
| Address1: | 2421 E SOUTHERN AVE | ||||||||
| Address2: | STE 1 | ||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852827612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804252160 | ||||||||
| FaxNumber: | 4803518797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2015 | ||||||||
| LastUpdateDate: | 11/04/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | CITRON | ||||||||
| AuthorizedOfficialFirstName: | GREGG | ||||||||
| AuthorizedOfficialMiddleName: | MARTIN | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4804252160 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 19985 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.