Provider Demographics
NPI:1659324606
Name:GREY FOX ANESTHESIA, P.A.
Entity type:Organization
Organization Name:GREY FOX ANESTHESIA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOLZY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-582-1938
Mailing Address - Street 1:PO BOX 9477
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-0025
Mailing Address - Country:US
Mailing Address - Phone:479-582-1938
Mailing Address - Fax:479-587-0484
Practice Address - Street 1:3396 N FUTRALL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4057
Practice Address - Country:US
Practice Address - Phone:479-582-1938
Practice Address - Fax:479-582-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-2260174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149447002Medicaid
AR149447002Medicaid