Provider Demographics
NPI:1578635892
Name:TEXAS HILL COUNTRY ANESTHESIA PA
Entity Type:Organization
Organization Name:TEXAS HILL COUNTRY ANESTHESIA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHAMPAGNE-MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-225-6345
Mailing Address - Street 1:PO BOX 141456
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78714
Mailing Address - Country:US
Mailing Address - Phone:512-225-6345
Mailing Address - Fax:512-692-5205
Practice Address - Street 1:7900 FM 1826
Practice Address - Street 2:SETON SOUTHWEST
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737
Practice Address - Country:US
Practice Address - Phone:512-324-9808
Practice Address - Fax:512-324-9086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24332207L00000X
TXL1048207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0038HDOtherBCBS
TX157276001Medicaid
TX157276001Medicaid
=========OtherTRICARE
B21358Medicare UPIN
TX157276001Medicaid