Provider Demographics
NPI:1225452774
Name:KENTUCKIANA ANESTHESIOLOGY, PLLC
Entity Type:Organization
Organization Name:KENTUCKIANA ANESTHESIOLOGY, PLLC
Other - Org Name:MEDICAL ANESTHESIA PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCWHORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-577-7635
Mailing Address - Street 1:5516 WEATHERBY LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3417
Mailing Address - Country:US
Mailing Address - Phone:214-577-7635
Mailing Address - Fax:972-612-5811
Practice Address - Street 1:5516 WEATHERBY LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3417
Practice Address - Country:US
Practice Address - Phone:214-577-7635
Practice Address - Fax:972-612-5811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5406207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148622704OtherMEDICAID CSHCN
TX0062ZPOtherBLUE CROSS BLUE SHIELD OF TEXAS
TX148622705OtherMEDICAID CSHCN
TX8227M8OtherBCBS
TX148622702Medicaid
7788421OtherCIGNA
TX148622703Medicaid
TX148622701Medicaid
902840910OtherUNIED HEALTHCARE
TX8644B1Medicare PIN
TX8B4304Medicare PIN
TX148622704OtherMEDICAID CSHCN
F76798Medicare UPIN
TX148622703Medicaid