Provider Demographics
NPI:1578513768
Name:ANESTHESIA CONSULTANTS OF DALLAS, LLP
Entity Type:Organization
Organization Name:ANESTHESIA CONSULTANTS OF DALLAS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:WINGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-946-1133
Mailing Address - Street 1:PO BOX 911589
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1589
Mailing Address - Country:US
Mailing Address - Phone:214-522-0210
Mailing Address - Fax:214-522-0474
Practice Address - Street 1:221 W COLORADO BLVD
Practice Address - Street 2:PAVILION II SUITE 845
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2363
Practice Address - Country:US
Practice Address - Phone:214-946-1133
Practice Address - Fax:214-946-3048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095062801Medicaid
TX00524KMedicare PIN