Organization
ISLAND ANESTHESIA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK ENOSA WILSON CRNA (PRESIDENT)
(801) 949-2629
Entity
Organization
Contact information
Practice address
1311 N MILDRED RD, CORTEZ, CO 81321-2231
(970) 564-2152
Mailing address
PO BOX 636, CORTEZ, CO 81321-0636
Taxonomy
Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
311030-4406
UT
Other
Enumeration date
05/06/2009
Last updated
12/07/2009
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