Provider Demographics
NPI:1144410226
Name:COMPLETE ANESTHESIA CARE, P.C.
Entity Type:Organization
Organization Name:COMPLETE ANESTHESIA CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:972-938-1623
Mailing Address - Street 1:1805 WOOD DUCK CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-9427
Mailing Address - Country:US
Mailing Address - Phone:972-938-1623
Mailing Address - Fax:
Practice Address - Street 1:106 LUCAS ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2202
Practice Address - Country:US
Practice Address - Phone:573-686-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1919623Medicaid
TXC84VOtherTX BCBS
TX1919623Medicaid