Provider Demographics
NPI:1497851190
Name:SOUTHWEST ANESTHESIA GROUP, P.A.
Entity Type:Organization
Organization Name:SOUTHWEST ANESTHESIA GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:915-779-1716
Mailing Address - Street 1:5959 GATEWAY BLVD W
Mailing Address - Street 2:STE. 120
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3331
Mailing Address - Country:US
Mailing Address - Phone:915-774-5539
Mailing Address - Fax:915-771-6558
Practice Address - Street 1:5959 GATEWAY BLVD W
Practice Address - Street 2:STE. 120
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-3331
Practice Address - Country:US
Practice Address - Phone:915-774-5539
Practice Address - Fax:915-771-6558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094933101Medicaid
TX00K80QOtherBCBS
TX00K80QOtherBCBS
TXCQ5017Medicare PIN