1649676024 NPI number — CHAMPION ANESTHESIA CONSULTANTS, PLLC

Table of content: (NPI 1649676024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649676024 NPI number — CHAMPION ANESTHESIA CONSULTANTS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHAMPION ANESTHESIA CONSULTANTS, PLLC
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:
1649676024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7167 COLLEYVILLE BLVD STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLEYVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76034-8002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-657-2030
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 E STATE HIGHWAY 114
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHLAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76092-3635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-865-4516
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/12/2014

Additional Information

Authorized Official

Authorized Official Last Name:
TYE
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
817-657-2030

Provider Taxonomy Codes

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

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





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