Provider Demographics
NPI:1225245368
Name:IV ANESTHESIA SERVICES PLLC
Entity Type:Organization
Organization Name:IV ANESTHESIA SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-520-8235
Mailing Address - Street 1:3930 CRUTCHER STREET
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1701
Mailing Address - Country:US
Mailing Address - Phone:214-520-8235
Mailing Address - Fax:214-520-8236
Practice Address - Street 1:3930 CRUTCHER STREET
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1701
Practice Address - Country:US
Practice Address - Phone:214-520-8235
Practice Address - Fax:214-520-8236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008262207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1225245368Medicaid
TXC97VOtherBLUE CROSS BLUE SHIELD
TX1225245368Medicaid