Provider Demographics
NPI:1114270931
Name:ENDO SEDATION LLC
Entity Type:Organization
Organization Name:ENDO SEDATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIA SUPPORT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-402-7526
Mailing Address - Street 1:550 RESERVE ST STE 560
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1607
Mailing Address - Country:US
Mailing Address - Phone:817-402-7526
Mailing Address - Fax:
Practice Address - Street 1:1001 SURREY LN
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4234
Practice Address - Country:US
Practice Address - Phone:817-337-3671
Practice Address - Fax:817-912-1887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C74YOtherBCBS OF TEXAS
TX267569Medicare UPIN