Provider Demographics
NPI:1346351640
Name:MESQUITE ANESTHESIOLOGY ASSOCIATION, PA
Entity Type:Organization
Organization Name:MESQUITE ANESTHESIOLOGY ASSOCIATION, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGARAJ
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIKKERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-681-7246
Mailing Address - Street 1:PO BOX 870638
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75187-0638
Mailing Address - Country:US
Mailing Address - Phone:972-681-7246
Mailing Address - Fax:972-681-8946
Practice Address - Street 1:3500 INTERSTATE 30
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2636
Practice Address - Country:US
Practice Address - Phone:972-698-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00416WMedicare PIN