1437118775 NPI number — WEATHERFORD ANESTHESIA ASSOCIATES, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437118775 NPI number — WEATHERFORD ANESTHESIA ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEATHERFORD ANESTHESIA ASSOCIATES, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437118775
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 163694
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76161-3694
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-991-1101
Provider Business Mailing Address Fax Number:
903-787-5854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
907 EUREKA ST
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
WEATHERFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76086-5880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-598-8150
Provider Business Practice Location Address Fax Number:
817-599-4902
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARMER
Authorized Official First Name:
JON-PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-599-4901

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 143321101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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