Organization
GRAND CANYON ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF PERRY (VP OF RCM)
(502) 418-4700
Entity
Organization
Contact information
Practice address
9787 N 91ST ST STE 103, SCOTTSDALE, AZ 85258-5088
(480) 657-0889
Mailing address
PO BOX 737732, DALLAS, TX 75373-7732
(888) 717-5383
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
426804
—
AZ
Enumeration date
08/22/2018
Last updated
08/11/2025
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