Provider Demographics
NPI:1629010269
Name:ST MARYS ANESTHESIA GROUP
Entity Type:Organization
Organization Name:ST MARYS ANESTHESIA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUS OFFICE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VERLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLGUIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-249-5800
Mailing Address - Street 1:PO BOX 1727
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73702-1727
Mailing Address - Country:US
Mailing Address - Phone:580-237-4435
Mailing Address - Fax:580-233-5671
Practice Address - Street 1:305 S 5TH ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5832
Practice Address - Country:US
Practice Address - Phone:580-233-6100
Practice Address - Fax:580-249-3730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty