Provider Demographics
NPI: | 1497091995 |
---|---|
Name: | CARDINAL ANESTHESIA MANAGEMENT SERVICES, LLC |
Entity Type: | Organization |
Organization Name: | CARDINAL ANESTHESIA MANAGEMENT SERVICES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO/PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TERRENCE |
Authorized Official - Middle Name: | BRANDON |
Authorized Official - Last Name: | JOHNSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 214-254-4672 |
Mailing Address - Street 1: | 1200 E COLLINS BLVD |
Mailing Address - Street 2: | SUITE 106 |
Mailing Address - City: | RICHARDSON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75081-2457 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 214-254-4672 |
Mailing Address - Fax: | 903-374-4711 |
Practice Address - Street 1: | 510 W TIDWELL RD |
Practice Address - Street 2: | |
Practice Address - City: | HOUSTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77091-4339 |
Practice Address - Country: | US |
Practice Address - Phone: | 281-618-4644 |
Practice Address - Fax: | 903-374-4711 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-01-02 |
Last Update Date: | 2013-01-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty |