1093043507 NPI number — GOLDEN TRIANGLE ANESTHESIA SERVICES, PC

Table of content: (NPI 1093043507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093043507 NPI number — GOLDEN TRIANGLE ANESTHESIA SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLDEN TRIANGLE ANESTHESIA SERVICES, PC
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:
JOANNE LEWIS, CRNA
Provider Other Organization Name Type Code:
3
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:
1093043507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 CHAPARRAL DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-612-1511
Provider Business Mailing Address Fax Number:
940-612-1511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
591 W. MAIN ST.
Provider Second Line Business Practice Location Address:
LEWISVILLE SURGERY CENTER
Provider Business Practice Location Address City Name:
LEWISVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-420-0023
Provider Business Practice Location Address Fax Number:
972-420-0731
Provider Enumeration Date:
11/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
940-612-1511

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  039687 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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