Provider Demographics
NPI:1144752700
Name:STRETFORD ANESTHESIA SERVICES PLLC
Entity Type:Organization
Organization Name:STRETFORD ANESTHESIA SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AZZAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-858-6531
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77549-0957
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1120 NASA PKWY
Practice Address - Street 2:220Q
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3320
Practice Address - Country:US
Practice Address - Phone:832-858-6531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDIFIT MEDICAL SOLUTIONS LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-31
Last Update Date:2017-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty