1497186092 NPI number — SPECIALIZED CRNA SERVICES L.L.C.

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 1497186092 NPI number — SPECIALIZED CRNA SERVICES L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIALIZED CRNA SERVICES L.L.C.
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:
1497186092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25511 BUDDE RD STE 2502
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THE WOODLANDS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77380-2388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-616-5560
Provider Business Mailing Address Fax Number:
866-475-9062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5115 MAIN ST STE 1000
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77002-9749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-580-2500
Provider Business Practice Location Address Fax Number:
713-580-2596
Provider Enumeration Date:
12/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ELLES
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-423-4422

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  501103/40277 , 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)

  • Identifier: 81995U . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 137815002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 430032292 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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