Provider Demographics
NPI:1003920828
Name:NORTH TEXAS ANESTHESIOLOGY,PLLC
Entity Type:Organization
Organization Name:NORTH TEXAS ANESTHESIOLOGY,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON-POLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-465-6043
Mailing Address - Street 1:PO BOX 1426
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75021-1426
Mailing Address - Country:US
Mailing Address - Phone:903-465-6043
Mailing Address - Fax:903-463-4496
Practice Address - Street 1:2402 W MORTON ST
Practice Address - Street 2:STE 146
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-1402
Practice Address - Country:US
Practice Address - Phone:903-465-6043
Practice Address - Fax:903-463-4496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R73WOtherMD GRP PROV #
TX00C21NOtherCRNA GRP PROV #
TX00R73WMedicare ID - Type UnspecifiedMD GROUP MC #
TXCD3437Medicare ID - Type UnspecifiedRR MC GRP PROV #
00C21NMedicare PIN
00R73WMedicare PIN
TX00C21NMedicare ID - Type UnspecifiedCRNA GRP MC #