Provider Demographics
NPI:1437349727
Name:SIESTA TEXAS ANESTHESIA PLLC
Entity Type:Organization
Organization Name:SIESTA TEXAS ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-682-4151
Mailing Address - Street 1:PO BOX 3744
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-3744
Mailing Address - Country:US
Mailing Address - Phone:956-682-4151
Mailing Address - Fax:956-682-4154
Practice Address - Street 1:1305 E NOLANA AVE
Practice Address - Street 2:SUITE H
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6114
Practice Address - Country:US
Practice Address - Phone:956-682-4151
Practice Address - Fax:956-682-4154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C76UOtherBCBS
TX198555801Medicaid
TX198555801Medicaid