Basic Information
| Provider Information | |||||||||
| NPI: | 1003173394 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN VICENTE ANESTHESIA SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1405 N FLORIDA ST | ||||||||
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| City: | SILVER CITY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880614225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736865550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1313 E 32ND ST | ||||||||
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| City: | SILVER CITY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880617251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755384000 | ||||||||
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| ProviderEnumerationDate: | 04/12/2012 | ||||||||
| LastUpdateDate: | 04/12/2012 | ||||||||
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| AuthorizedOfficialLastName: | RUDD | ||||||||
| AuthorizedOfficialFirstName: | AARON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5736865550 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | NM | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.