Provider Demographics
NPI:1396024956
Name:JSTA ANESTHESIA SERVICES PLLC
Entity Type:Organization
Organization Name:JSTA ANESTHESIA SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:318-469-4470
Mailing Address - Street 1:1515 N TOWN EAST BLVD STE 138
Mailing Address - Street 2:BOX 441
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4142
Mailing Address - Country:US
Mailing Address - Phone:318-469-4470
Mailing Address - Fax:
Practice Address - Street 1:1515 N TOWN EAST BLVD STE 138
Practice Address - Street 2:BOX 441
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4142
Practice Address - Country:US
Practice Address - Phone:318-469-4470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX637818367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty