Provider Demographics
NPI:1477828028
Name:PSA ANESTHESIA PLLC
Entity Type:Organization
Organization Name:PSA ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTFAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-876-7246
Mailing Address - Street 1:PO BOX 208379
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-8379
Mailing Address - Country:US
Mailing Address - Phone:855-876-7246
Mailing Address - Fax:844-364-8678
Practice Address - Street 1:4100 DUVAL RD
Practice Address - Street 2:BLDG 3 SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3550
Practice Address - Country:US
Practice Address - Phone:855-876-7246
Practice Address - Fax:855-277-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty