NPIMap

Organization Active NPI

South Towne Anesthesia LLC

  • Anesthesiology Physician
  • Draper, UT
National Provider Identifier
1457061533
Registry record updated Nov 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
SOUTH TOWNE ANESTHESIA LLC
Practice address
96 E Kimballs LN
Draper, UT 84020-5020
Phone
(801) 233-9300
NPI assigned
Nov 30, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2022

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

Authorized official

Name
Tony GianoulisNPI 1720183221
Title
Authorized Official
Phone
(801) 571-2824

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

96 E Kimballs LN
Draper, UT 84020-5020

Mailing address

PO Box 3570
Salt Lake City, UT 84110-3570

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230419003080 UT Part B Supplier - Clinic/Group Practice 3870958176 Receives reassigned benefits from 24 practitioners
Practice locations: Draper, UT

National Provider Directory

National Provider Directory

Locations

96 E Kimballs Ln
Ste 100
Draper, UT 84020
Phone (801) 233-9300

96 E Kimballs Ln
Draper, UT 84020
Phone (801) 233-9300

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1669766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669766400000",
    "number": "1457061533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3570",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841103570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 E KIMBALLS LN",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840205020",
            "telephone_number": "801-233-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH TOWNE ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-30",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A",
        "authorized_official_last_name": "GIANOULIS",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "801-571-2824"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Draper, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.