Provider Demographics
NPI:1588622815
Name:DENTON ANESTHESIOLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:DENTON ANESTHESIOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIENT LIAISON
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-334-0530
Mailing Address - Street 1:PO BOX 163258
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-3258
Mailing Address - Country:US
Mailing Address - Phone:800-224-5203
Mailing Address - Fax:817-334-0235
Practice Address - Street 1:3000 N I-35
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-5119
Practice Address - Country:US
Practice Address - Phone:800-224-5203
Practice Address - Fax:817-334-0235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090146401Medicaid
TX090146402Medicaid
TX090146401Medicaid
TX090146402Medicaid