Organization
GILA ANESTHESIOLOGY SERVICES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON S FANNIN (DIRECTOR)
(765) 284-0493
Entity
Organization
Contact information
Practice address
1313 E 32ND ST, SILVER CITY, NM 88061-7251
(505) 538-4000
Mailing address
1801 N WALNUT ST, MUNCIE, IN 47303-1953
(765) 284-0493
(765) 213-3240
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30409861
—
NM
05
—
7400047
—
NM
05
—
89080874
—
NM
Enumeration date
06/03/2006
Last updated
08/22/2020
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