Provider Demographics
NPI:1033271192
Name:NORTH TEXAS ANESTHESIA CONSULTANTS, PA
Entity Type:Organization
Organization Name:NORTH TEXAS ANESTHESIA CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:RACCASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-369-0800
Mailing Address - Street 1:PO BOX 952106
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75395-0001
Mailing Address - Country:US
Mailing Address - Phone:214-369-0800
Mailing Address - Fax:214-378-5311
Practice Address - Street 1:7557 RAMBLER RD
Practice Address - Street 2:STE 706
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2320
Practice Address - Country:US
Practice Address - Phone:214-369-0800
Practice Address - Fax:214-378-5311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159470701Medicaid
TX159470701Medicaid