Organization
IPS OF PHOENIX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL R. NOBACK MD (OWNER)
(941) 360-1566
Entity
Organization
Contact information
Practice address
16222 N 59TH AVE, SUITE A-100, GLENDALE, AZ 85306-1701
(941) 360-1566
Mailing address
16222 N 59TH AVE STE A115, GLENDALE, AZ 85306-1706
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
04/06/2009
Last updated
06/29/2011
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