Provider Demographics
NPI:1548359128
Name:SQUAW PEAK ANESTHESIA INC
Entity type:Organization
Organization Name:SQUAW PEAK ANESTHESIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA, BSN, MAE
Authorized Official - Phone:602-300-6383
Mailing Address - Street 1:PO BOX 81024
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85069-1024
Mailing Address - Country:US
Mailing Address - Phone:602-525-4977
Mailing Address - Fax:602-938-4954
Practice Address - Street 1:10701 W BELL RD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-1074
Practice Address - Country:US
Practice Address - Phone:602-525-4977
Practice Address - Fax:602-938-4954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWDCFVMedicare PIN