Arizona Wellness Anesthesia Group, Inc

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

37002 Issued in AZ

Legal business name

ARIZONA WELLNESS ANESTHESIA GROUP, INC

Practice address

6005 S 36TH St
Phoenix, AZ 85042-4901

Phone

(602) 595-5145

Fax

(602) 595-5302

NPI assigned

Jul 10, 2008

Organization subpart

No

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

Authorized official

Name

Igor Kravchenko, MD

Title

Owner

Phone

(602) 595-5145

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462838400000",
    "number": "1265696124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6005 S 36TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850424901",
            "telephone_number": "602-595-5145",
            "fax_number": "602-595-5302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6005 S 36TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850424901",
            "telephone_number": "602-595-5145",
            "fax_number": "602-595-5302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA WELLNESS ANESTHESIA GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-10",
        "last_updated": "2016-05-10",
        "status": "A",
        "authorized_official_last_name": "KRAVCHENKO",
        "authorized_official_first_name": "IGOR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-595-5145",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "AZ",
            "license": "37002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "354648",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Anesthesiology Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Anesthesiology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2016; 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.