Provider Demographics
NPI:1447719539
Name:NOVA ANESTHESIOLOGISTS & PERIOPERATIVE SERVICES
Entity type:Organization
Organization Name:NOVA ANESTHESIOLOGISTS & PERIOPERATIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-272-8411
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-0160
Mailing Address - Country:US
Mailing Address - Phone:480-272-8411
Mailing Address - Fax:480-361-1435
Practice Address - Street 1:8102 E MCDOWELL RD STE 2A
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3819
Practice Address - Country:US
Practice Address - Phone:480-421-1014
Practice Address - Fax:480-421-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ622427Medicaid