Provider Demographics
NPI:1225026115
Name:LIMESTONE COUNTY ANESTHESIA ASSOCIATES PA
Entity Type:Organization
Organization Name:LIMESTONE COUNTY ANESTHESIA ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-677-1000
Mailing Address - Street 1:PO BOX 1849
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75802-1849
Mailing Address - Country:US
Mailing Address - Phone:903-677-1000
Mailing Address - Fax:903-677-1694
Practice Address - Street 1:4002 S LOOP 256
Practice Address - Street 2:SUITE N
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8491
Practice Address - Country:US
Practice Address - Phone:903-677-1000
Practice Address - Fax:903-677-1694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2009-08-27
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
TX1594731-01Medicaid
00233VMedicare PIN
DA2055Medicare PIN