1700815883 NPI number — CAPITOL ANESTHESIOLOGY ASSOCIATION

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 1700815883 NPI number — CAPITOL ANESTHESIOLOGY ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITOL ANESTHESIOLOGY ASSOCIATION
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:
1700815883
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3705 MEDICAL PKWY
Provider Second Line Business Mailing Address:
SUITE 570
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78705-1019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-583-2701
Provider Business Mailing Address Fax Number:
512-583-2797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3705 MEDICAL PKWY
Provider Second Line Business Practice Location Address:
SUITE 570
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78705-1019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-583-2701
Provider Business Practice Location Address Fax Number:
512-583-2797
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HENDRIX
Authorized Official First Name:
HARRY
Authorized Official Middle Name:
LEONARD
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
512-583-2701

Provider Taxonomy Codes

  • Taxonomy code: 173000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Z000N031 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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