Provider Demographics
NPI:1255319158
Name:B. R. A. ANESTHESIA, PC
Entity Type:Organization
Organization Name:B. R. A. ANESTHESIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, CRNA
Authorized Official - Phone:214-399-0034
Mailing Address - Street 1:2241 F. M. 984
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-0955
Mailing Address - Country:US
Mailing Address - Phone:214-399-0034
Mailing Address - Fax:972-646-5278
Practice Address - Street 1:2241 F. M. 984
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-0955
Practice Address - Country:US
Practice Address - Phone:214-399-0034
Practice Address - Fax:972-646-5278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX705290367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX888174OtherBLUE CROSS BLUE SHIELD
TX1762759-02Medicaid