1588622815 NPI number — DENTON ANESTHESIOLOGY ASSOCIATES, PA

Table of content: (NPI 1588622815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588622815 NPI number — DENTON ANESTHESIOLOGY ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTON ANESTHESIOLOGY 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:
1588622815
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 163258
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:
76161-3258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-224-5203
Provider Business Mailing Address Fax Number:
817-334-0235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 N I-35
Provider Second Line Business Practice Location Address:
DEPARTMENT OF ANESTHESIOLOGY
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76201-5119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-224-5203
Provider Business Practice Location Address Fax Number:
817-334-0235
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEARD
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
CLIENT LIAISON
Authorized Official Telephone Number:
817-334-0530

Provider Taxonomy Codes

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

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

  • Identifier: 090146401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 090146402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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