Provider Demographics
NPI:1568508380
Name:TIMOTHY ROSS LEE, PC
Entity Type:Organization
Organization Name:TIMOTHY ROSS LEE, PC
Other - Org Name:MAVERICK ANESTHESIA SERVICES, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUIAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-416-6775
Mailing Address - Street 1:2840 KELLER SPRINGS RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-4829
Mailing Address - Country:US
Mailing Address - Phone:972-416-6775
Mailing Address - Fax:972-417-9624
Practice Address - Street 1:5327 N CENTRAL EXPY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3361
Practice Address - Country:US
Practice Address - Phone:214-520-8235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253403367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C88SOtherBCBS
TX00C88SOtherBCBS