Justin Wayne Fuller, | |
1400 S Dobson Rd, Mesa, AZ 85202-4707 | |
(972) 761-5508 | |
Not Available |
Full Name | Justin Wayne Fuller |
---|---|
Gender | Male |
Speciality | Certified Registered Nurse Anesthetist (crna) |
Experience | 3 Years |
Location | 1400 S Dobson Rd, Mesa, Arizona |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1962176917 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
367500000X | Nurse Anesthetist, Certified Registered | 264564 (Arizona) | Primary |
367500000X | Nurse Anesthetist, Certified Registered | RN185391 (Arizona) | Secondary |
Facility Name | Location | Facility Type |
---|---|---|
Banner - University Medical Center Phoenix | Phoenix, AZ | Hospital |
Banner Desert Medical Center | Mesa, AZ | Hospital |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Banner - University Hospital Based Physicians Llc | 1052614294 | 255 |
Grand Canyon Anesthesia Llc | 3678824752 | 40 |
Anesthesia Partners Of Arizona Llc | 8628317179 | 184 |
Entity Name | Arizona Advanced Anesthesia Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1134479892 PECOS PAC ID: 0941454953 Enrollment ID: O20130129000024 |
Entity Name | Banner - University Hospital Based Physicians Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1750751566 PECOS PAC ID: 1052614294 Enrollment ID: O20160122000508 |
Entity Name | Grand Canyon Anesthesia Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1356822902 PECOS PAC ID: 3678824752 Enrollment ID: O20180928002378 |
Entity Name | Anesthesia Partners Of Arizona Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1619452901 PECOS PAC ID: 8628317179 Enrollment ID: O20190228001927 |
Entity Name | Hospitalist Medicine Physicians Of Arizona - Nogales |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1487251799 PECOS PAC ID: 9335554625 Enrollment ID: O20210218002429 |
Mailing Address | Practice Location Address |
---|---|
Justin Wayne Fuller, 1400 S Dobson Rd, Mesa, AZ 85202-4707 Ph: (972) 761-5508 | Justin Wayne Fuller, 1400 S Dobson Rd, Mesa, AZ 85202-4707 Ph: (972) 761-5508 |
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