Provider Demographics
NPI:1467465369
Name:THE SOUTH COUNTY ANESTHESIA ASSOCIATION, PA
Entity Type:Organization
Organization Name:THE SOUTH COUNTY ANESTHESIA ASSOCIATION, PA
Other - Org Name:THE WOODLANDS ANESTHESIA ASSOCIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-776-7300
Mailing Address - Street 1:PO BOX 200649
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-0649
Mailing Address - Country:US
Mailing Address - Phone:281-580-9030
Mailing Address - Fax:281-580-2725
Practice Address - Street 1:3115 COLLEGE PARK DR
Practice Address - Street 2:UNIT 103C
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4000
Practice Address - Country:US
Practice Address - Phone:281-580-9030
Practice Address - Fax:281-580-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5017174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00B75SMedicare PIN