NPIMap

Organization Active NPI

Old Pueblo Anesthesia

  • Anesthesiology Physician
  • Tucson, AZ
National Provider Identifier
1194770768
Registry record updated May 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
OLD PUEBLO ANESTHESIA
Practice address
2810 N Swan Rd
Suite 100
Tucson, AZ 85712-6305
Phone
(520) 324-2030
Fax
(520) 445-6019
NPI assigned
May 23, 2006
Last updated
May 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Kristy Fresh, HCM, MBA, FACMPE, LS
Title
Administrator
Phone
(520) 324-2030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

2810 N Swan Rd
Suite 100
Tucson, AZ 85712-6305

Mailing address

2810 N Swan Rd
Suite 100
Tucson, AZ 85712-6300
Phone (520) 324-2030

Other identifiers 1

IdentifierTypeStateIssuer
096736MedicaidAZ

National Provider Directory

National Provider Directory

Locations

2810 N Swan Rd
Ste 100
Tucson, AZ 85712
Phone (520) 324-2030

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589500800000",
    "number": "1194770768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 N SWAN RD",
            "address_2": "SUITE 100",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857126300",
            "telephone_number": "520-324-2030",
            "fax_number": "520-445-6019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 N SWAN RD",
            "address_2": "SUITE 100",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857126305",
            "telephone_number": "520-324-2030",
            "fax_number": "520-445-6019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD PUEBLO ANESTHESIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2020-05-15",
        "certification_date": "2020-05-15",
        "status": "A",
        "authorized_official_last_name": "FRESH",
        "authorized_official_first_name": "KRISTY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "520-324-2030",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "HCM, MBA, FACMPE, LS"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "096736",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.