Provider Demographics
NPI:1457659815
Name:ALTAIR ANESTHESIA PC
Entity Type:Organization
Organization Name:ALTAIR ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-394-1851
Mailing Address - Street 1:4541 GLENVILLE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3322
Mailing Address - Country:US
Mailing Address - Phone:469-438-8053
Mailing Address - Fax:972-212-7129
Practice Address - Street 1:4541 GLENVILLE DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3322
Practice Address - Country:US
Practice Address - Phone:469-438-8053
Practice Address - Fax:972-212-7129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty