Basic Information
| Provider Information | |||||||||
| NPI: | 1902363757 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ECLIPSE ANESTHESIA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3717 SOUTH HIGELY ROAD | ||||||||
| Address2: | STE 114, PMB 298 | ||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024817369 | ||||||||
| FaxNumber: | 4804521464 | ||||||||
| Practice Location | |||||||||
| Address1: | 2620 N 3RD ST | ||||||||
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| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850041153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024893391 | ||||||||
| FaxNumber: | 6024521464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2019 | ||||||||
| LastUpdateDate: | 09/16/2019 | ||||||||
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| AuthorizedOfficialLastName: | BECKER | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINA | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6024817369 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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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.