Provider Demographics
NPI:1275938862
Name:CBS ANESTHESIA, PLLC
Entity Type:Organization
Organization Name:CBS ANESTHESIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:BENTON
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:901-619-4043
Mailing Address - Street 1:4519 N GARFIELD ST
Mailing Address - Street 2:SUITE 15
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-3415
Mailing Address - Country:US
Mailing Address - Phone:432-699-0225
Mailing Address - Fax:432-520-2723
Practice Address - Street 1:4519 N GARFIELD ST
Practice Address - Street 2:SUITE 15
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-3415
Practice Address - Country:US
Practice Address - Phone:432-699-0225
Practice Address - Fax:432-520-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-26
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP123239367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty