Provider Demographics
NPI:1356318513
Name:ANESTHESIA CONSULTANTS OF FREDERICKSBURG
Entity Type:Organization
Organization Name:ANESTHESIA CONSULTANTS OF FREDERICKSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:830-997-9170
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-0233
Mailing Address - Country:US
Mailing Address - Phone:830-997-9170
Mailing Address - Fax:830-997-9226
Practice Address - Street 1:415 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4636
Practice Address - Country:US
Practice Address - Phone:830-997-9170
Practice Address - Fax:830-997-9226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079675701Medicaid
TX00047HMedicare PIN