Provider Demographics
NPI:1598949661
Name:ANESTHESIA OF NORTH TEXAS, PA
Entity Type:Organization
Organization Name:ANESTHESIA OF NORTH TEXAS, PA
Other - Org Name:ANT
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-265-4844
Mailing Address - Street 1:1001 N WALDROP DR STE 701
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4704
Mailing Address - Country:US
Mailing Address - Phone:817-265-4844
Mailing Address - Fax:817-265-1449
Practice Address - Street 1:1001 N WALDROP DR STE 701
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4704
Practice Address - Country:US
Practice Address - Phone:817-265-4844
Practice Address - Fax:817-265-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11117101Medicaid
TX00C07WOtherBLUECROSS/BLUE SHIELD