Provider Demographics
NPI:1437326857
Name:VALLEY ANESTHESIOLOGY CONSULTANTS-BECKETT-PLLC
Entity type:Organization
Organization Name:VALLEY ANESTHESIOLOGY CONSULTANTS-BECKETT-PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:STURDIVANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-924-5057
Mailing Address - Street 1:PO BOX 400310
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140
Mailing Address - Country:US
Mailing Address - Phone:318-924-5057
Mailing Address - Fax:702-405-7960
Practice Address - Street 1:10120 S EASTERN AVE STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3952
Practice Address - Country:US
Practice Address - Phone:318-924-5057
Practice Address - Fax:908-653-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1437326857Medicaid