1366775850 NPI number — GREATER TEXAS ANESTHESIA & PAIN MANAGEMENT, PA

Table of content: (NPI 1366775850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366775850 NPI number — GREATER TEXAS ANESTHESIA & PAIN MANAGEMENT, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER TEXAS ANESTHESIA & PAIN MANAGEMENT, 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:
1366775850
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5760 LEGACY DR # B3-119
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75024-7102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-458-2828
Provider Business Mailing Address Fax Number:
940-458-2522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
807 N 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANGER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76266-4414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-458-2828
Provider Business Practice Location Address Fax Number:
940-458-2522
Provider Enumeration Date:
09/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
AGHA
Authorized Official First Name:
TASNEEM
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
940-458-2828

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  K4347 , 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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