Provider Demographics
NPI:1659337186
Name:REGIONAL ANESTHESIA ASSOCIATES P A
Entity Type:Organization
Organization Name:REGIONAL ANESTHESIA ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOOMOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:361-985-1221
Mailing Address - Street 1:4444 CORONA DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4324
Mailing Address - Country:US
Mailing Address - Phone:361-985-1221
Mailing Address - Fax:361-985-1295
Practice Address - Street 1:4444 CORONA DR
Practice Address - Street 2:SUITE 215
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4324
Practice Address - Country:US
Practice Address - Phone:361-985-1221
Practice Address - Fax:361-985-1295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081632401Medicaid
00AL08Medicare PIN